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General NPI Number Information
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NPI Number | 1578558789
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Entity Type | Individual
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Provider Name | KAMAL KUMAR TIWARI M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/14/2005
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Last Update Date | 02/12/2010
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Provider Practice Location Address
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Address Line | 2920 MCINTYRE DR SUITE 150
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City | BLOOMINGTON
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State | IN
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Zip | 47403-4221
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Country | US
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Telephone | 812-333-7246
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Fax | 812-333-4471
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Provider Business Mailing Address
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Address Line | PO BOX 5635 ATTN MANOJ KUMAR
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City | BLOOMINGTON
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State | IN
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Zip | 47407-5635
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Country | US
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Telephone | 812-337-5003
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Fax | 812-337-5010
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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 | 01034945A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 01034945A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 01034945A
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License Number State | IN
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