Provider Demographics
NPI:1548482763
Name:PYLAWKA, TAMARA K (MD)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:K
Last Name:PYLAWKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 W BETHEL AVE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-5407
Mailing Address - Country:US
Mailing Address - Phone:765-664-2671
Mailing Address - Fax:765-664-3703
Practice Address - Street 1:1389 N BALDWIN AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-1913
Practice Address - Country:US
Practice Address - Phone:765-664-2671
Practice Address - Fax:765-664-3703
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01076966A207X00000X
IL036-133317207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201388550Medicaid
IL036133317Medicaid
IN207610021OtherMEDICARE
ILF400102742Medicare PIN