Individual
KAMAL KUMAR TIWARI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2920 MCINTYRE DR, SUITE 150, BLOOMINGTON, IN 47403-4221
(812) 333-7246
(812) 333-4471
Mailing address
PO BOX 5635, ATTN MANOJ KUMAR, BLOOMINGTON, IN 47407-5635
(812) 337-5003
(812) 337-5010
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
01034945A
IN
207LP2900X
Pain Medicine (Anesthesiology) Physician
01034945A
IN
208VP0014X
Interventional Pain Medicine Physician
Primary
01034945A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000076245
PMC ANTHEM
IN
01
—
000000378036
SIA ANTHEM
IN
05
—
100184000A
—
IN
05
—
100184000C
—
IN
05
—
100184000D
—
IN
05
—
100184000E
—
IN
05
—
100184000F
—
IN
05
—
100184000J
—
IN
Enumeration date
09/14/2005
Last updated
02/12/2010
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