Provider Demographics
NPI:1154388619
Name:TUNA, ISHIK C (MD)
Entity type:Individual
Prefix:DR
First Name:ISHIK
Middle Name:C
Last Name:TUNA
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 1:3546 N LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-8410
Mailing Address - Country:US
Mailing Address - Phone:336-712-1516
Mailing Address - Fax:
Practice Address - Street 1:3546 N LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-8410
Practice Address - Country:US
Practice Address - Phone:336-712-1516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039290A208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
INE88966Medicare UPIN
IN357740Medicare ID - Type UnspecifiedFEDERAL MEDICARE PROVIDER