Provider Demographics
NPI:1376518761
Name:RANDHAWA, NITI KAUR (MD)
Entity Type:Individual
Prefix:DR
First Name:NITI
Middle Name:KAUR
Last Name:RANDHAWA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:12200 PARK CENTRAL DR
Mailing Address - Street 2:STE 189
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-2100
Mailing Address - Country:US
Mailing Address - Phone:469-587-8480
Mailing Address - Fax:469-587-8484
Practice Address - Street 1:12200 PARK CENTRAL DR
Practice Address - Street 2:STE 415
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-2100
Practice Address - Country:US
Practice Address - Phone:469-587-8480
Practice Address - Fax:469-587-8484
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2017-07-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXK2988207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH54498Medicare UPIN
H54498Medicare UPIN
007122S33Medicare ID - Type Unspecified
TX0A3488Medicare PIN
H54498Medicare UPIN
VA010145937Medicaid