Provider Demographics
NPI:1871788745
Name:TEWARI, KRISHNA (MD)
Entity type:Individual
Prefix:
First Name:KRISHNA
Middle Name:
Last Name:TEWARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 N MARION ST FL 2
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-4914
Mailing Address - Country:US
Mailing Address - Phone:813-474-9804
Mailing Address - Fax:813-540-6025
Practice Address - Street 1:203 N MARION ST FL 2
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-4914
Practice Address - Country:US
Practice Address - Phone:813-474-9804
Practice Address - Fax:813-540-6025
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME107206207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00844094OtherRR MEDICARE
FL002250200Medicaid
FL002250200Medicaid
FLDJ672X - UCCMedicare PIN
FLDJ672Y - TPAMedicare PIN
FL002250200Medicaid