Provider Demographics
NPI:1104118553
Name:KIRTANE, TEJAS (MD)
Entity type:Individual
Prefix:DR
First Name:TEJAS
Middle Name:
Last Name:KIRTANE
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 1:6431 FANNIN ST
Mailing Address - Street 2:MSB 4.234 (DIVISION OF GASTROENTEROLOGY)
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1501
Mailing Address - Country:US
Mailing Address - Phone:713-500-6672
Mailing Address - Fax:713-500-6699
Practice Address - Street 1:3909 CREEKSIDE LOOP STE 120
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902
Practice Address - Country:US
Practice Address - Phone:509-249-6616
Practice Address - Fax:509-225-2708
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-04
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10048784207RG0100X
390200000X
WAMD60688672207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program