Provider Demographics
NPI:1477534436
Name:KOHLI, RAJAN S (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJAN
Middle Name:S
Last Name:KOHLI
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:PO BOX 720323
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75372-0323
Mailing Address - Country:US
Mailing Address - Phone:903-806-5892
Mailing Address - Fax:
Practice Address - Street 1:1405 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-2231
Practice Address - Country:US
Practice Address - Phone:972-923-7144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1843207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1755647-13Medicaid
TX175564701Medicaid
TX8AQ504OtherBLUE CROSS
TX2001075-01Medicaid
TXTXB136174Medicare PIN
TX2001075-01Medicaid
TX1755647-13Medicaid
0A0236Medicare PIN
TX8K8646Medicare PIN
TX8D8236Medicare ID - Type Unspecified
TX8AQ504OtherBLUE CROSS