Healthcare Provider Details

I. General information

NPI: 1851332829
Provider Name (Legal Business Name): KIRAN C TAMIRISA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 NAVARRE AVE
OREGON OH
43616-3207
US

IV. Provider business mailing address

2600 NAVARRE AVE PAIN CLINIC
OREGON OH
43616-3207
US

V. Phone/Fax

Practice location:
  • Phone: 419-696-7646
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35045601
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number13332
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number35045601
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: