Healthcare Provider Details

I. General information

NPI: 1366658627
Provider Name (Legal Business Name): NISHANT SINGH RANAWAT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 04/28/2023
Certification Date: 04/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9180 PINECROFT DR STE 500
SHENANDOAH TX
77380-3883
US

IV. Provider business mailing address

1553 DEVONSHIRE PL
MEDFORD OR
97504-7201
US

V. Phone/Fax

Practice location:
  • Phone: 713-897-2300
  • Fax:
Mailing address:
  • Phone: 216-396-7455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberMD192398
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License NumberMD192398
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: