Provider Demographics
NPI:1144549692
Name:TIWARI, TATULYA (MD)
Entity type:Individual
Prefix:DR
First Name:TATULYA
Middle Name:
Last Name:TIWARI
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:1500 E MEDICAL CENTER DRIVE
Mailing Address - Street 2:UH B1D530
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-5030
Mailing Address - Country:US
Mailing Address - Phone:734-647-4144
Mailing Address - Fax:734-615-1276
Practice Address - Street 1:1500 E. MEDICAL CENTER DR #B1F510K
Practice Address - Street 2:RAD: DIAGNOSTIC RADIOLOGY
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-5030
Practice Address - Country:US
Practice Address - Phone:734-936-4338
Practice Address - Fax:734-615-3506
Is Sole Proprietor?:No
Enumeration Date:2010-05-24
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43011069292085R0204X
IN11015479A390200000X
VA0116023309390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program