Provider Demographics
NPI:1033184486
Name:TIPIRNENI, KISHORE (MD)
Entity Type:Individual
Prefix:DR
First Name:KISHORE
Middle Name:
Last Name:TIPIRNENI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19636 N 27TH AVE STE 401
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4021
Mailing Address - Country:US
Mailing Address - Phone:602-298-8888
Mailing Address - Fax:602-978-4129
Practice Address - Street 1:19636 N 27TH AVE STE 401
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-4021
Practice Address - Country:US
Practice Address - Phone:602-298-8888
Practice Address - Fax:602-978-4129
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24200207X00000X, 207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ362872Medicaid
AZ3Z3942OtherHEALTHNET
AZ3Z3942OtherHEALTHNET
AZZ137022Medicare PIN