Provider Demographics
NPI:1407841117
Name:TAPAL, MUJTABA F (MD)
Entity type:Individual
Prefix:
First Name:MUJTABA
Middle Name:F
Last Name:TAPAL
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2060 E PARRISH AVE
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1448
Mailing Address - Country:US
Mailing Address - Phone:270-684-5034
Mailing Address - Fax:270-685-1874
Practice Address - Street 1:2060 E PARRISH AVE
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1448
Practice Address - Country:US
Practice Address - Phone:270-684-5034
Practice Address - Fax:270-685-1874
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059296A207RR0500X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200499180DMedicaid
KY64090368Medicaid
IN200499180DMedicaid
G52503Medicare UPIN
KY64090368Medicaid