Healthcare Provider Details

I. General information

NPI: 1205929510
Provider Name (Legal Business Name): AJIT KUMAR TIWARI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 11/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 N EVERBROOK LN
MUNCIE IN
47304-5269
US

IV. Provider business mailing address

3700 N EVERBROOK LN
MUNCIE IN
47304-5269
US

V. Phone/Fax

Practice location:
  • Phone: 765-281-1181
  • Fax: 765-282-4768
Mailing address:
  • Phone: 765-281-1181
  • Fax: 765-282-4768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number01039897A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: