Healthcare Provider Details

I. General information

NPI: 1750405015
Provider Name (Legal Business Name): RAJANARENDER R. CHOLLETI, MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 08/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1161 SW WILSHIRE BLVD SUITE 115
BURLESON TX
76028-5707
US

IV. Provider business mailing address

1161 SW WILSHIRE BLVD SUITE 115
BURLESON TX
76028-5707
US

V. Phone/Fax

Practice location:
  • Phone: 817-426-4700
  • Fax: 817-426-4737
Mailing address:
  • Phone: 817-426-4700
  • Fax: 817-426-4737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberL0089
License Number StateTX

VIII. Authorized Official

Name: MRS. DEBORAH L MOSES
Title or Position: OFFICE MANAGER
Credential:
Phone: 817-426-4700