Provider Demographics
NPI:1154352763
Name:TEJWANI, INDURANI (MD)
Entity type:Individual
Prefix:MS
First Name:INDURANI
Middle Name:
Last Name:TEJWANI
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 1:6005 PARK AVE
Mailing Address - Street 2:STE 508
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119
Mailing Address - Country:US
Mailing Address - Phone:901-683-7319
Mailing Address - Fax:901-683-7310
Practice Address - Street 1:6005 PARK AVE
Practice Address - Street 2:STE 508
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119
Practice Address - Country:US
Practice Address - Phone:901-683-7319
Practice Address - Fax:901-683-7310
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD7366207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3157284Medicare ID - Type Unspecified
B59263Medicare UPIN