Basic Information
| Provider Information | |||||||||
| NPI: | 1407841117 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAPAL | ||||||||
| FirstName: | MUJTABA | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3868 | ||||||||
| Address2: | |||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477373868 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124269311 | ||||||||
| FaxNumber: | 8124269839 | ||||||||
| Practice Location | |||||||||
| Address1: | 421 CHESTNUT ST | ||||||||
| Address2: | |||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477131227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124269311 | ||||||||
| FaxNumber: | 8124269839 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2005 | ||||||||
| LastUpdateDate: | 01/09/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RR0500X | 01059296A | IN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
ID Information
| ID | Type | State | Issuer | Description | 200499180D | 05 | IN | MEDICAID | 64090368 | 05 | KY | MEDICAID |