Provider Demographics
NPI:1992740278
Name:SHIWACH, RAJINDER (MD)
Entity type:Individual
Prefix:DR
First Name:RAJINDER
Middle Name:
Last Name:SHIWACH
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 1:4606 CHEROKEE TRL
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75209-1916
Mailing Address - Country:US
Mailing Address - Phone:972-283-6286
Mailing Address - Fax:214-217-4819
Practice Address - Street 1:941 YORK DRIVE STE 205
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2242
Practice Address - Country:US
Practice Address - Phone:972-283-6286
Practice Address - Fax:214-217-4819
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK22882084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX140817101Medicaid
TX00432MMedicare ID - Type Unspecified
TX140817101Medicaid