Healthcare Provider Details

I. General information

NPI: 1104119171
Provider Name (Legal Business Name): ASHISH K TIWARI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2011
Last Update Date: 04/22/2022
Certification Date: 04/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1185 TOWN CENTRE DR STE 205
EAGAN MN
55123-1370
US

IV. Provider business mailing address

201 PARK ST
BOWLING GREEN KY
42101-1759
US

V. Phone/Fax

Practice location:
  • Phone: 612-871-1145
  • Fax: 612-870-5491
Mailing address:
  • Phone: 270-781-5111
  • Fax: 270-780-0475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number49817
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: