Provider Demographics
NPI:1174696884
Name:TIWARI, PARITOSH
Entity type:Individual
Prefix:DR
First Name:PARITOSH
Middle Name:
Last Name:TIWARI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 HERITAGE DR
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-2701
Mailing Address - Country:US
Mailing Address - Phone:815-937-4880
Mailing Address - Fax:815-936-5173
Practice Address - Street 1:20 HERITAGE DR
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-2701
Practice Address - Country:US
Practice Address - Phone:815-937-4880
Practice Address - Fax:815-936-5173
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363094959207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036085017Medicaid
IL036085017Medicaid
IL212016Medicare PIN