Healthcare Provider Details

I. General information

NPI: 1376890400
Provider Name (Legal Business Name): TANIA AHLUWALIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2012
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 GILLHAM RD
KANSAS CITY MO
64108-4619
US

IV. Provider business mailing address

9700 N DALEA LN APT 14115
PEORIA IL
61615-7037
US

V. Phone/Fax

Practice location:
  • Phone: 480-478-5144
  • Fax:
Mailing address:
  • Phone: 480-478-5144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number61683146
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125062398
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: