Basic Information
| Provider Information | |||||||||
| NPI: | 1245292606 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TEWARI | ||||||||
| FirstName: | RAJIV | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10995 ALLISONVILLE RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | FISHERS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460382616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1784279283 | ||||||||
| FaxNumber: | 3178413337 | ||||||||
| Practice Location | |||||||||
| Address1: | 10995 ALLISONVILLE RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | FISHERS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460382616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178427928 | ||||||||
| FaxNumber: | 3178413337 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2006 | ||||||||
| LastUpdateDate: | 09/13/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | 01052497A | IN | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 208VP0000X | 01052497A | IN | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 200286720 | 05 | IN | MEDICAID |