Provider Demographics
NPI:1356317655
Name:PANDIT, RAJIV TIKOO (MD)
Entity Type:Individual
Prefix:MR
First Name:RAJIV
Middle Name:TIKOO
Last Name:PANDIT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 N BECKLEY AVE
Mailing Address - Street 2:PAV III SUITE 363
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203-1259
Mailing Address - Country:US
Mailing Address - Phone:214-946-3687
Mailing Address - Fax:214-946-0687
Practice Address - Street 1:1411 N BECKLEY AVE
Practice Address - Street 2:PAV III SUITE 363
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-1259
Practice Address - Country:US
Practice Address - Phone:214-946-3687
Practice Address - Fax:214-946-0687
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1686174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A7264Medicare ID - Type Unspecified
TXH45185Medicare UPIN