Healthcare Provider Details

I. General information

NPI: 1013545516
Provider Name (Legal Business Name): VISHWAS TIWARI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 W GRAND BLVD HENRY FORD HOSPITAL, MEDICAL EDUCATION DEPARTMENT
DETROIT MI
48202-2608
US

IV. Provider business mailing address

2799 W GRAND BLVD HENRY FORD HOSPITAL, MEDICAL EDUCATION DEPARTMENT
DETROIT MI
48202-2608
US

V. Phone/Fax

Practice location:
  • Phone: 313-916-3581
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: