Basic Information
| Provider Information | |||||||||
| NPI: | 1083807184 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DHOLAKIA | ||||||||
| FirstName: | RISHI | ||||||||
| MiddleName: | TEJAS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO, MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 INDIANA AVE | ||||||||
| Address2: | |||||||||
| City: | WINSLOW | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 860472169 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9282894646 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 500 INDIANA AVE | ||||||||
| Address2: | |||||||||
| City: | WINSLOW | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 860472169 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9282894646 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2007 | ||||||||
| LastUpdateDate: | 05/22/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 295701 | NY | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | DO179438 | OR | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | P 6376 | TX | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 20A 11963 | CA | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 008337 | AZ | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.