MEDICARE: DR. NITI KAUR RANDHAWA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	K2988	TX

General Provider Information

NPI Number	:	1376518761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NITI KAUR RANDHAWA MD

Provider Business Mailing Address
First Line	:	12200 PARK CENTRAL DR
Second Line	:	STE 189
City	:	DALLAS
State	:	TX
Zip	:	75251-2100
Country	:	US
Telephone Number	:	469-587-8480
Fax Number	:	469-587-8484

Provider Business Practice Location Address
First Line	:	12200 PARK CENTRAL DR
Second Line	:	STE 415
City	:	DALLAS
State	:	TX
Zip	:	75251-2100
Country	:	US
Telephone Number	:	469-587-8480
Fax Number	:	469-587-8484

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	07/28/2017

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