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General NPI Number Information
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NPI Number | 1811189269
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Entity Type | Individual
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Provider Name | TEJASWI BHARI THIPPESWAMY MD,
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Gender | Male
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Dates
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Enumeration Date | 08/09/2007
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Last Update Date | 01/23/2020
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Provider Practice Location Address
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Address Line | 1400 W 4TH
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City | COFFEYVILLE
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State | KS
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Zip | 67337-3306
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Country | US
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Telephone | 209-383-7441
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Fax |
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Provider Business Mailing Address
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Address Line | 1910 CUSTOMER CARE WAY
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City | ATWATER
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State | CA
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Zip | 95301-5167
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Country | US
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Telephone | 209-384-6488
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Fax | 855-202-9336
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 25886
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | E6737
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A132344
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0442440
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License Number State | KS
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