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General NPI Number Information
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NPI Number | 1174784243
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Entity Type | Individual
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Provider Name | KISHORE ANOOP TOLANI
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Gender | Male
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Dates
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Enumeration Date | 06/21/2008
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Last Update Date | 05/20/2011
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Provider Practice Location Address
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Address Line | 489 STATE ST
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City | BANGOR
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State | ME
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Zip | 04401-6616
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Country | US
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Telephone | 207-973-5918
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Fax |
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Provider Business Mailing Address
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Address Line | 840 STATE ST APT 8
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City | BANGOR
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State | ME
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Zip | 04401-5683
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Country | US
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Telephone | 609-364-0088
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 018339
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License Number State | ME
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