Provider Demographics
NPI:1548217441
Name:TIWARI, SUBHASH R (MD)
Entity Type:Individual
Prefix:DR
First Name:SUBHASH
Middle Name:R
Last Name:TIWARI
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 1:726 20TH ST
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-5442
Mailing Address - Country:US
Mailing Address - Phone:772-257-5264
Mailing Address - Fax:772-257-5265
Practice Address - Street 1:726 20TH ST
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5442
Practice Address - Country:US
Practice Address - Phone:772-257-5264
Practice Address - Fax:772-257-5265
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00391172084P0800X
FLME391172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY22645 (INACTIVE)OtherWISCONSIN BOARD OF MEDICINE (PHYSICIANS' LICENSE)
IL36059800 (INACTIVE)OtherILLINOIS DEPT. OF PROFESSIONAL REGULATION (PHYSICIANS' LICENSE)
FLME39117OtherFLORIDA STATE LICENSE
FL066934200Medicaid
IL36059800 (INACTIVE)OtherILLINOIS DEPT. OF PROFESSIONAL REGULATION (PHYSICIANS' LICENSE)
AT9057034OtherFEDERAL DEA LICENSE