Provider Demographics
NPI:1043248032
Name:TEWARI, ASHEESH (MD)
Entity Type:Individual
Prefix:DR
First Name:ASHEESH
Middle Name:
Last Name:TEWARI
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 1:25230 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1715
Mailing Address - Country:US
Mailing Address - Phone:313-441-2227
Mailing Address - Fax:313-441-2241
Practice Address - Street 1:25230 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-1715
Practice Address - Country:US
Practice Address - Phone:134-412-2273
Practice Address - Fax:313-441-2241
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005008376207W00000X
MI4301078018207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
199360OtherMO-BLUE SHIELD
134471Medicare UPIN
199360OtherMO-BLUE SHIELD