Provider Demographics
NPI:1649201195
Name:POUW, TIONG OEN (MD)
Entity Type:Individual
Prefix:MR
First Name:TIONG
Middle Name:OEN
Last Name:POUW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2451 INTELLIPLEX DR
Mailing Address - Street 2:STE 280
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46176-8580
Mailing Address - Country:US
Mailing Address - Phone:317-392-0222
Mailing Address - Fax:317-392-0722
Practice Address - Street 1:2451 INTELLIPLEX DR
Practice Address - Street 2:STE 280
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-8580
Practice Address - Country:US
Practice Address - Phone:317-392-0222
Practice Address - Fax:317-392-0722
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01039967A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100224800Medicaid
IN100224800Medicaid
IN741980Medicare ID - Type Unspecified