| Niti Randhawa,m.d., Pa | |
|
12200 Park Central Dr Ste 189 Dallas TX 75251-2116 | |
| (469) 584-8480 | |
| (469) 587-8484 |
| Full Name | Niti Randhawa,m.d., Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 12200 Park Central Dr Ste 189, Dallas, Texas |
| Authorized Official Name and Position | Ninety Nine Credentialing Services (CREDENTIALING) |
| Authorized Official Contact | 9727925700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Niti Randhawa,m.d., Pa 9101 Lbj Freeway Ste 710 Dallas TX 75243-1912 Ph: (972) 792-5700 | Niti Randhawa,m.d., Pa 12200 Park Central Dr Ste 189 Dallas TX 75251-2116 Ph: (469) 584-8480 |
| NPI Number | 1649420787 |
|---|---|
| Provider Enumeration Date | 09/25/2008 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 9032276563 |
|---|---|
| Medicare Enrollment ID | O20090326000626 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649420787 | NPI | - | NPPES |
| 193400000X | Other | TX | TAXONOMY |
| K2988 | Other | TX | TX LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | K2988 (Texas) | Primary |
| Provider Name | Niti K Randhawa |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376518761 PECOS PAC ID: 2961440458 Enrollment ID: I20090326000623 |
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