Provider Demographics
NPI:1255341202
Name:CHEE-AWAI, RANDALL J (MD)
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:J
Last Name:CHEE-AWAI
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 1:3650 W WHEATLAND RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-3494
Mailing Address - Country:US
Mailing Address - Phone:972-572-8380
Mailing Address - Fax:972-572-8387
Practice Address - Street 1:3650 W WHEATLAND RD
Practice Address - Street 2:SUITE B
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3494
Practice Address - Country:US
Practice Address - Phone:972-572-8380
Practice Address - Fax:972-572-8387
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0675207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX031155702Medicaid
TXK0675OtherTEXAS STATE LICENSE
TX8B1415Medicare ID - Type UnspecifiedMEDICARE
TX031155702Medicaid