Healthcare Provider Details

I. General information

NPI: 1891006417
Provider Name (Legal Business Name): MANISH M TIWARI MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2010
Last Update Date: 03/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EMILE 42ND ST
OMAHA NE
68198-0001
US

IV. Provider business mailing address

988102 NEBRASKA MEDICAL CTR
OMAHA NE
68198-8102
US

V. Phone/Fax

Practice location:
  • Phone: 402-552-6731
  • Fax: 402-552-6730
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number27427
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: