Provider Demographics
NPI:1659710077
Name:KVASLERUD, TORE (MD:)
Entity Type:Individual
Prefix:DR
First Name:TORE
Middle Name:
Last Name:KVASLERUD
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 1:1520 N SENATE AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-2213
Mailing Address - Country:US
Mailing Address - Phone:317-962-8893
Mailing Address - Fax:
Practice Address - Street 1:300 20TH AVE N FL 789
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2131
Practice Address - Country:US
Practice Address - Phone:615-284-1400
Practice Address - Fax:615-284-1420
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN54427207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ023054Medicaid
TN103I080870Medicare PIN