Provider Demographics
NPI:1750589016
Name:RAJ.SHIWACH, M.D., P.A.
Entity type:Organization
Organization Name:RAJ.SHIWACH, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJINDER
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHIWACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-283-6286
Mailing Address - Street 1:941 YORK DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2065
Mailing Address - Country:US
Mailing Address - Phone:972-283-6286
Mailing Address - Fax:214-217-4819
Practice Address - Street 1:941 YORK DR
Practice Address - Street 2:SUITE 205
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2065
Practice Address - Country:US
Practice Address - Phone:972-283-6286
Practice Address - Fax:972-331-8748
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RAJ.SHIWACH, M.D., P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-10
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2288261QM0850X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1408171-01Medicaid
TX1408171-01Medicaid