Provider Demographics
NPI:1396749966
Name:TISINAI, KAREN ANN (MD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:ANN
Last Name:TISINAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-4214
Mailing Address - Country:US
Mailing Address - Phone:812-242-3110
Mailing Address - Fax:812-242-3795
Practice Address - Street 1:1429 N 6TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-1037
Practice Address - Country:US
Practice Address - Phone:812-242-3110
Practice Address - Fax:812-242-3795
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039405A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN351904269208Medicaid
P00315180OtherRAILROAD MEDICARE PIN
IN100177110AMedicaid
000000384161OtherANTHEM
IN100177110TMedicaid
INP00834925OtherRAILROAD MEDICARE
000000384161OtherANTHEM
P00315180OtherRAILROAD MEDICARE PIN
E90718Medicare UPIN
IN192770FFFFMedicare PIN