Provider Demographics
NPI:1023278439
Name:TEJWANI, AJAY (MD)
Entity type:Individual
Prefix:
First Name:AJAY
Middle Name:
Last Name:TEJWANI
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 1:330 ARKANSAS ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-1335
Mailing Address - Country:US
Mailing Address - Phone:785-749-3600
Mailing Address - Fax:785-749-3621
Practice Address - Street 1:330 ARKANSAS ST
Practice Address - Street 2:SUITE 120
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-1335
Practice Address - Country:US
Practice Address - Phone:785-749-3600
Practice Address - Fax:785-749-3621
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-363992085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201077880CMedicaid
KS068002447Medicare PIN