Provider Demographics
NPI:1699877670
Name:BANWAIT, KULDIP SINGH (MD)
Entity type:Individual
Prefix:DR
First Name:KULDIP
Middle Name:SINGH
Last Name:BANWAIT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50537
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79159-0537
Mailing Address - Country:US
Mailing Address - Phone:806-354-9400
Mailing Address - Fax:806-354-9403
Practice Address - Street 1:800 QUAIL CREEK DR
Practice Address - Street 2:SUITE 101
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79124-1634
Practice Address - Country:US
Practice Address - Phone:806-354-9400
Practice Address - Fax:806-354-9403
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4993207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AW200 / 0031QWOtherBCBS PIN
TXM4993OtherMEDICAL LICENSE NUMBER
TX00149690OtherDPS NUMBER
TX197441201Medicaid
TXPO0606672OtherRAILROAD MEDICARE
TX7830853OtherAETNA US HEALTHCARE
TX00Y904OtherMEDICARE GRP PIN
TX00Y904OtherMEDICARE GRP PIN
TX8AW200 / 0031QWOtherBCBS PIN
TX00149690OtherDPS NUMBER