Healthcare Provider Details

I. General information

NPI: 1952381600
Provider Name (Legal Business Name): THOMAS OKULSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 N ACCESS RD SUITE D
CHATTANOOGA TN
37415-3812
US

IV. Provider business mailing address

1395 S PINELLAS AVE
TARPON SPRINGS FL
34689-3790
US

V. Phone/Fax

Practice location:
  • Phone: 423-826-1276
  • Fax: 423-826-1290
Mailing address:
  • Phone: 941-624-7032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME-0027052
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: