Provider Demographics
NPI:1194767749
Name:TULI, SANJEEV Y (MD)
Entity type:Individual
Prefix:DR
First Name:SANJEEV
Middle Name:Y
Last Name:TULI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SANJEEV
Other - Middle Name:YASHVIR
Other - Last Name:TULI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 HARBORSIDE DR
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-0001
Practice Address - Country:US
Practice Address - Phone:409-772-3695
Practice Address - Fax:409-772-3680
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX48517208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252874600Medicaid
G68524Medicare UPIN