Healthcare Provider Details

I. General information

NPI: 1881743821
Provider Name (Legal Business Name): LUTFI T TOMBULOGLU MD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 11/09/2022
Certification Date: 11/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4325 S 60TH ST
GREENFIELD WI
53220-3508
US

IV. Provider business mailing address

4325 S 60TH ST
GREENFIELD WI
53220-3508
US

V. Phone/Fax

Practice location:
  • Phone: 414-545-5500
  • Fax: 414-545-5335
Mailing address:
  • Phone: 414-545-5500
  • Fax: 414-545-5335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number17161-020
License Number StateWI

VIII. Authorized Official

Name: DR. BEDRIYE TOMBULOGLU
Title or Position: PRESIDENT
Credential: MD
Phone: 414-545-5500