Provider Demographics
NPI:1346348919
Name:KHANDELWAL, BAL KRISHNA (MD)
Entity type:Individual
Prefix:DR
First Name:BAL
Middle Name:KRISHNA
Last Name:KHANDELWAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6113 MARTINOVE STREET
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024
Mailing Address - Country:US
Mailing Address - Phone:432-352-0334
Mailing Address - Fax:
Practice Address - Street 1:PRIMARY CARE CLINIC OF NORTH TEXAS (CHARITY CLINIC)
Practice Address - Street 2:3900 AMERICAN DRIVE, #201
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075
Practice Address - Country:US
Practice Address - Phone:972-596-6005
Practice Address - Fax:972-596-6004
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2022-02-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXE9266207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82Z930OtherMEDICARE PROVIDER NUMBER
TX085583501Medicaid
TXB23925Medicare UPIN