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General NPI Number Information
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NPI Number | 1750589016
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Entity Type | Organization
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Legal Business Name | RAJ.SHIWACH, M.D., P.A.
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Dates
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Enumeration Date | 07/10/2007
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Last Update Date | 09/11/2012
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Provider Practice Location Address
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Address Line | 941 YORK DR SUITE 205
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City | DESOTO
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State | TX
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Zip | 75115-2065
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Country | US
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Telephone | 972-283-6286
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Fax | 972-331-8748
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Provider Business Mailing Address
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Address Line | 941 YORK DR SUITE 205
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City | DESOTO
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State | TX
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Zip | 75115-2065
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Country | US
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Telephone | 972-283-6286
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Fax | 214-217-4819
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | DR. RAJINDER S. SHIWACH
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Credential | M.D.
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Telephone | 972-283-6286
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | K2288
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | K2288
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License Number State | TX
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