MEDICARE: NAMITA TULI 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	174400000X	Specialist	P0802	TX
2	208M00000X	Hospitalist Physician	D0063730	MD

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00332447	OTHER		MEDICARE RAILROAD

General Provider Information

NPI Number	:	1689623597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAMITA TULI MD

Provider Business Mailing Address
First Line	:	PO BOX 1368
Second Line	:
City	:	MUSTANG
State	:	OK
Zip	:	73064-8368
Country	:	US
Telephone Number	:	405-745-9600
Fax Number	:

Provider Business Practice Location Address
First Line	:	10141 US 59TH
Second Line	:
City	:	WHARTON
State	:	TX
Zip	:	77488-7224
Country	:	US
Telephone Number	:	979-531-0101
Fax Number	:

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

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	12/07/2011

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