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General NPI Number Information
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NPI Number | 1992980767
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Entity Type | Individual
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Provider Name | TANYANAN TANAWUTTIWAT M.D.
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Gender | Female
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Dates
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Enumeration Date | 12/29/2007
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Last Update Date | 07/26/2025
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Provider Practice Location Address
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Address Line | 1701 N SENATE BLVD HEART STATION A1089
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-1239
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Country | US
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Telephone | 317-962-8447
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Fax |
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Provider Business Mailing Address
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Address Line | 250 N SHADELAND AVE STE 200
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-4959
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Country | US
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Telephone | 317-963-3137
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 01083239A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 23750
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 207RC0001X
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Taxonomy Name | Clinical Cardiac Electrophysiology Physician
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License Number | 312475
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 207RC0001X
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Taxonomy Name | Clinical Cardiac Electrophysiology Physician
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License Number | 01083239A
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License Number State | IN
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