Provider Demographics
NPI:1962089110
Name:GREWAL, NICHOLAS KIRAN SINGH (MD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:KIRAN SINGH
Last Name:GREWAL
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 1:1725 W HARRISON ST STE 1159
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3883
Mailing Address - Country:US
Mailing Address - Phone:888-352-7847
Mailing Address - Fax:
Practice Address - Street 1:1725 W HARRISON ST STE 1159
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3883
Practice Address - Country:US
Practice Address - Phone:888-352-7847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.078034207R00000X
IL036166905207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine