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General NPI Number Information
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NPI Number | 1265619993
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Entity Type | Individual
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Provider Name | JOHN OWEN TULLY MD
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Gender | Male
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Dates
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Enumeration Date | 01/24/2008
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Last Update Date | 01/19/2024
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Provider Practice Location Address
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Address Line | 7580 NORTHCLIFF AVE STE 1000
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City | BROOKLYN
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State | OH
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Zip | 44144-3271
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Country | US
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Telephone | 440-808-1212
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Fax | 440-808-0321
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Provider Business Mailing Address
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Address Line | 850 COLUMBIA RD STE 200
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City | WESTLAKE
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State | OH
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Zip | 44145-7215
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Country | US
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Telephone | 216-767-5664
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 35.097547
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License Number State | OH
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