Provider Demographics
NPI:1184733156
Name:RAJ, SHEKHAR SIDDAPPA (MD)
Entity type:Individual
Prefix:
First Name:SHEKHAR
Middle Name:SIDDAPPA
Last Name:RAJ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAJASHEKHAR
Other - Middle Name:
Other - Last Name:SIDDAPPA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 660645
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0645
Mailing Address - Country:US
Mailing Address - Phone:361-694-5445
Mailing Address - Fax:361-694-5449
Practice Address - Street 1:3533 S ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-1721
Practice Address - Country:US
Practice Address - Phone:361-694-5445
Practice Address - Fax:361-694-5449
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010532632080P0203X, 207LC0200X
TXQ7598208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036103896Medicaid
IN200338070Medicaid
LA1810967Medicaid
INP01824553OtherRR MEDICARE
KY7100316660Medicaid
GA022990723AMedicaid
VT1021332Medicaid
IL036103896Medicaid
IN200338070Medicaid
LA1810967Medicaid