Provider Demographics
NPI:1962580258
Name:TULIMAT, MOHAMMAD A (M D)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:A
Last Name:TULIMAT
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 DECLARATION DR
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41051-7983
Mailing Address - Country:US
Mailing Address - Phone:859-363-3330
Mailing Address - Fax:859-359-5478
Practice Address - Street 1:2025 DECLARATION DR
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KY
Practice Address - Zip Code:41051-7983
Practice Address - Country:US
Practice Address - Phone:859-363-3330
Practice Address - Fax:859-359-5478
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301079635207R00000X
OH35-124503207R00000X
KY42299207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0123044Medicaid
KY7100097830Medicaid
OH0123044Medicaid
KYK073501Medicare PIN
MIN8240003Medicare PIN
KY01080002Medicare PIN