Provider Demographics
NPI:1447361092
Name:MAHAL, KANWALJIT S (MD)
Entity type:Individual
Prefix:
First Name:KANWALJIT
Middle Name:S
Last Name:MAHAL
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:SONNY
Other - Middle Name:
Other - Last Name:MAHAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6102 82ND ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-0802
Mailing Address - Country:US
Mailing Address - Phone:806-771-0077
Mailing Address - Fax:806-771-3175
Practice Address - Street 1:6102 82ND ST
Practice Address - Street 2:SUITE 5
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-0802
Practice Address - Country:US
Practice Address - Phone:806-771-0077
Practice Address - Fax:806-771-3175
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4316208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX186224502Medicaid
TX8DD063OtherBCBS
TX7224844OtherAETNA
TX186224502Medicaid
TX8DD063OtherBCBS
TXP00384679OtherMEDICARE RAILROAD
TXTXB146783Medicare PIN
TX5892790001Medicare NSC
TXP00384679OtherMEDICARE RAILROAD