1750589016 NPI number — RAJ SHIWACH, MD, PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750589016 NPI number — RAJ SHIWACH, MD, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAJ SHIWACH, MD, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750589016
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
941 YORK DR
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
DESOTO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75115-2066
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-884-5601
Provider Business Mailing Address Fax Number:
214-452-3060

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
941 YORK DR
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
DESOTO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75115-2066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-884-5601
Provider Business Practice Location Address Fax Number:
214-452-3060
Provider Enumeration Date:
07/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
SHERRI
Authorized Official Middle Name:
Authorized Official Title or Position:
ACCOUNTANT
Authorized Official Telephone Number:
469-964-6827

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X , with the licence number:  K2288 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: K2288 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1408171-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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