1205929510 NPI number — AJIT KUMAR TIWARI MD

Table of content: AJIT KUMAR TIWARI MD (NPI 1205929510)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205929510 NPI number — AJIT KUMAR TIWARI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TIWARI
Provider First Name:
AJIT
Provider Middle Name:
KUMAR
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205929510
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3700 N EVERBROOK LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MUNCIE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47304-5269
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-281-1181
Provider Business Mailing Address Fax Number:
765-282-4768

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3700 N EVERBROOK LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MUNCIE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47304-5269
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-281-1181
Provider Business Practice Location Address Fax Number:
765-282-4768
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  01039897A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100094420E , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 180027935 . This is a "RR MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000219038 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 036119147 . This is a "STATE LICENSE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 000000219038 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 10236450000 . This is a "TRICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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