Healthcare Provider Details

I. General information

NPI: 1851822456
Provider Name (Legal Business Name): EMILY COLLINS TIWANA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2017
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE ST
LEXINGTON KY
40536-1675
US

IV. Provider business mailing address

7001 HAMPTON CREEK CT
LOUISVILLE KY
40241-6425
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-2222
  • Fax: 859-323-5090
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number56512
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: