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General NPI Number Information
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NPI Number | 1649420787
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Entity Type | Organization
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Legal Business Name | NITI RANDHAWA,M.D., PA
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Dates
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Enumeration Date | 09/25/2008
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 12200 PARK CENTRAL DR STE 189
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City | DALLAS
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State | TX
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Zip | 75251-2116
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Country | US
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Telephone | 469-584-8480
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Fax | 469-587-8484
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Provider Business Mailing Address
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Address Line | 9101 LBJ FREEWAY STE 710
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City | DALLAS
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State | TX
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Zip | 75243-1912
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Country | US
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Telephone | 972-792-5700
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Fax | 214-506-1170
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Authorized Official
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Title or Position | CREDENTIALING
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Name | NINETY NINE CREDENTIALING SERVICES
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Credential |
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Telephone | 972-792-5700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | K2988
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License Number State | TX
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