MEDICARE: SOUTHERN INDIANA ANESTHESIOLOGY

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	207L00000X	Anesthesiology Physician		IN

General Provider Information

NPI Number	:	1548255615
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN INDIANA ANESTHESIOLOGY

Provider Business Mailing Address
First Line	:	PO BOX 5635
Second Line	:	ATTN: MARIA MITCHELL
City	:	BLOOMINGTON
State	:	IN
Zip	:	47407-5635
Country	:	US
Telephone Number	:	812-824-5688
Fax Number	:	812-824-5692

Provider Business Practice Location Address
First Line	:	2920 MCINTYRE DR
Second Line	:	SUITE 150
City	:	BLOOMINGTON
State	:	IN
Zip	:	47403-4221
Country	:	US
Telephone Number	:	812-333-7246
Fax Number	:	812-333-4471

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KAMAL KUMAR TIWARI
Credential	:	MD
Telephone Number	:	812-333-7246

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	11/14/2007

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Directions to “SOUTHERN INDIANA ANESTHESIOLOGY ” Practice Location

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