Individual
MANSOOR I. TIWANA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 E CHESTNUT ST BLDG SUITE303, LOUISVILLE, KY 40202
(502) 629-5552
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01072444A
IN
207R00000X
Internal Medicine Physician
44189
KY
207R00000X
Internal Medicine Physician
MD432054
PA
207RN0300X
Nephrology Physician
Primary
44189
KY
208M00000X
Hospitalist Physician
MD432054
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000609439
ANTHEM
KY
01
—
01072444A
INDIANA LICENSE
IN
05
—
1019486730001
—
PA
05
—
1019486730002
—
PA
05
—
1019486730003
—
PA
01
—
1747437
AETNA
PA
01
—
1973534
HIGHMARK BLUE SHIELD
PA
01
—
2852822000
PERSONAL CHOICE
PA
01
—
30043623
KEYSTONE MERCY
PA
01
—
34935,34936,34937
HEALTH PARTNERS
PA
01
—
44189
KY LICENSE
KY
05
—
7100177580
—
KY
Enumeration date
06/18/2007
Last updated
07/28/2022
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