Healthcare Provider Details

I. General information

NPI: 1457926669
Provider Name (Legal Business Name): NISHANT RAJENDRA TIWARI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2021
Last Update Date: 09/01/2024
Certification Date: 09/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 NE 10TH ST FL 6
OKLAHOMA CITY OK
73104-5418
US

IV. Provider business mailing address

LOYOLA MEDICINE MCNEAL HOSPITAL 3249 SOUTH OAK PARK AVE
BERWYN IL
60402
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-8001
  • Fax: 405-271-3020
Mailing address:
  • Phone: 708-783-3401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number43744
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: