Provider Demographics
NPI:1578907978
Name:TEJWANI, VICKRAM (MD)
Entity Type:Individual
Prefix:
First Name:VICKRAM
Middle Name:
Last Name:TEJWANI
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 1:9500 EUCLID AVE
Mailing Address - Street 2:NA1-17
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-372-0711
Mailing Address - Fax:216-445-6290
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:NA1-17
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-372-0711
Practice Address - Fax:216-445-6290
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-29
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.127445207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine