Basic Information
| Provider Information | |||||||||
| NPI: | 1649420787 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NITI RANDHAWA,M.D., PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9101 LBJ FREEWAY | ||||||||
| Address2: | STE 710 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752431912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727925700 | ||||||||
| FaxNumber: | 2145061170 | ||||||||
| Practice Location | |||||||||
| Address1: | 12200 PARK CENTRAL DR STE 189 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752512116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4695848480 | ||||||||
| FaxNumber: | 4695878484 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2008 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | CREDENTIALING SERVICES | ||||||||
| AuthorizedOfficialFirstName: | NINETY NINE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 9727925700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | K2988 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 193400000X | 01 | TX | TAXONOMY | OTHER | K2988 | 01 | TX | TX LICENSE | OTHER |