Individual
DR. KIMBERLY K TYUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2600 FERRY ST, LAFAYETTE, IN 47904-3055
(765) 448-8000
Mailing address
PO BOX 5545, LAFAYETTE, IN 47903-5545
(765) 448-8000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
BS5741663
MO
208M00000X
Hospitalist Physician
Primary
01068081A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000656862
ANTHEM PROVIDER NUMBER
IN
05
—
200980500
—
IN
Enumeration date
08/18/2007
Last updated
02/14/2011
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