MEDICARE: KAILASH C TARNEJA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	R5C73	MO

General Provider Information

NPI Number	:	1417022781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAILASH C TARNEJA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 707
Second Line	:
City	:	WEST PLAINS
State	:	MO
Zip	:	65775-0707
Country	:	US
Telephone Number	:	417-257-7451
Fax Number	:	417-256-9277

Provider Business Practice Location Address
First Line	:	3102 INDEPENDENCE SQUARE
Second Line	:
City	:	WEST PLAINS
State	:	MO
Zip	:	65775-4235
Country	:	US
Telephone Number	:	417-257-7451
Fax Number	:	417-256-9277

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	07/08/2007

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