MEDICARE: JOHN OWEN TULLY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	35.097547	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00992476	OTHER	OH	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265619993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN OWEN TULLY MD

Provider Business Mailing Address
First Line	:	850 COLUMBIA RD
Second Line	:	STE 200
City	:	WESTLAKE
State	:	OH
Zip	:	44145-7215
Country	:	US
Telephone Number	:	216-767-5664
Fax Number	:

Provider Business Practice Location Address
First Line	:	7580 NORTHCLIFF AVE STE 1000
Second Line	:
City	:	BROOKLYN
State	:	OH
Zip	:	44144-3271
Country	:	US
Telephone Number	:	440-808-1212
Fax Number	:	440-808-0321

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2008
Last Update Date	:	01/19/2024

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Directions to “ JOHN OWEN TULLY MD” Practice Location

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