Healthcare Provider Details

I. General information

NPI: 1336133347
Provider Name (Legal Business Name): LAL KUMAR TANWANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 05/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 BLUEGRASS AVE SUITE 108
LOUISVILLE KY
40215-1144
US

IV. Provider business mailing address

1900 BLUEGRASS AVE SUITE 108
LOUISVILLE KY
40215-1144
US

V. Phone/Fax

Practice location:
  • Phone: 502-361-2524
  • Fax: 502-361-2525
Mailing address:
  • Phone: 502-361-2524
  • Fax: 502-361-2525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number35300
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number01063197A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35300
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: