Provider Demographics
NPI:1659687788
Name:AGARWAL, RAJENDER (MD MPH)
Entity type:Individual
Prefix:DR
First Name:RAJENDER
Middle Name:
Last Name:AGARWAL
Suffix:
Gender:M
Credentials:MD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 N KIMBALL AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-4747
Mailing Address - Country:US
Mailing Address - Phone:817-704-0847
Mailing Address - Fax:682-323-0794
Practice Address - Street 1:1360 N KIMBALL AVE STE 100
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-4747
Practice Address - Country:US
Practice Address - Phone:817-704-0847
Practice Address - Fax:682-323-0794
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-26
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR1923207R00000X
MS22638207R00000X
IL125056092207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty