Provider Demographics
NPI:1629072335
Name:KUSHWAHA, RAJNIKANT (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJNIKANT
Middle Name:
Last Name:KUSHWAHA
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 1:150 PINE FOREST DR
Mailing Address - Street 2:SUITE 604
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77384-5302
Mailing Address - Country:US
Mailing Address - Phone:936-273-4666
Mailing Address - Fax:936-271-4666
Practice Address - Street 1:150 PINE FOREST DR STE 604
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77384-5304
Practice Address - Country:US
Practice Address - Phone:936-273-4666
Practice Address - Fax:936-271-4666
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2022-08-15
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-21
Provider Licenses
StateLicense IDTaxonomies
TXK7323207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDG7841OtherMEDICARE RAILROAD
TX043998602Medicaid
TX043998602Medicaid