Provider Demographics
NPI:1336133347
Name:TANWANI, LAL KUMAR (MD)
Entity Type:Individual
Prefix:MR
First Name:LAL
Middle Name:KUMAR
Last Name:TANWANI
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 1:1900 BLUEGRASS AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40215-1144
Mailing Address - Country:US
Mailing Address - Phone:502-361-2524
Mailing Address - Fax:502-361-2525
Practice Address - Street 1:1900 BLUEGRASS AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1144
Practice Address - Country:US
Practice Address - Phone:502-361-2524
Practice Address - Fax:502-361-2525
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35300207RE0101X, 207R00000X
IN01063197A207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200855050A (KOHMG)Medicaid
KY64055551Medicaid
H69360Medicare UPIN
KY0997801Medicare PIN
KYP01634710 RR (KOHMG)Medicare PIN
IN200855050A (KOHMG)Medicaid