| Raj.shiwach, M.d., P.a. | |
|
941 York Dr Suite 205 Desoto TX 75115-2065 | |
| (972) 283-6286 | |
| (972) 331-8748 |
| Full Name | Raj.shiwach, M.d., P.a. |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 941 York Dr, Desoto, Texas |
| Authorized Official Name and Position | Rajinder S. Shiwach (CEO/PRESIDENT) |
| Authorized Official Contact | 9722836286 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Raj.shiwach, M.d., P.a. 941 York Dr Suite 205 Desoto TX 75115-2065 Ph: (972) 283-6286 | Raj.shiwach, M.d., P.a. 941 York Dr Suite 205 Desoto TX 75115-2065 Ph: (972) 283-6286 |
| NPI Number | 1750589016 |
|---|---|
| Provider Enumeration Date | 07/10/2007 |
| Last Update Date | 09/11/2012 |
| Medicare PECOS PAC ID | 4587744560 |
|---|---|
| Medicare Enrollment ID | O20080307000607 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750589016 | NPI | - | NPPES |
| 1408171-01 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | K2288 (Texas) | Primary |
| 261QM0850X | Clinic/center - Adult Mental Health | K2288 (Texas) | Secondary |
| Provider Name | Rajinder S Shiwach |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1992740278 PECOS PAC ID: 2466540190 Enrollment ID: I20080307000605 |
| Provider Name | Innocent Omale |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326548637 PECOS PAC ID: 6608127279 Enrollment ID: I20180920000822 |
| Provider Name | Roel Sepulveda |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326518085 PECOS PAC ID: 2163764085 Enrollment ID: I20190425000349 |
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