Provider Demographics
NPI:1861881112
Name:RAJ SHIWACH, MDPA
Entity type:Organization
Organization Name:RAJ SHIWACH, MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJINDER
Authorized Official - Middle Name:
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:
Mailing Address - Fax:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA09191363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty