Provider Demographics
NPI:1417022781
Name:TARNEJA, KAILASH C (MD)
Entity type:Individual
Prefix:
First Name:KAILASH
Middle Name:C
Last Name:TARNEJA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 707
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-0707
Mailing Address - Country:US
Mailing Address - Phone:417-257-7451
Mailing Address - Fax:417-256-9277
Practice Address - Street 1:3102 INDEPENDENCE SQUARE
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-4235
Practice Address - Country:US
Practice Address - Phone:417-257-7451
Practice Address - Fax:417-256-9277
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR5C732085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA14089Medicare UPIN