Healthcare Provider Details

I. General information

NPI: 1457426082
Provider Name (Legal Business Name): UMESH KUMAR TIWARI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7219 N LITCHFIELD RD
LUKE AFB AZ
85309-1529
US

IV. Provider business mailing address

530 E MCDOWELL RD # 107-622
PHOENIX AZ
85004-1549
US

V. Phone/Fax

Practice location:
  • Phone: 623-856-2274
  • Fax: 623-856-2777
Mailing address:
  • Phone: 951-200-5183
  • Fax: 800-508-2215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA93224
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number43345
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: