=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902172786
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CTMD LLC DBA PARKSIDE HEART CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2012
-----------------------------------------------------
Last Update Date | 07/17/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 455 E PIKES PEAK AVE SUITE 100
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80903-3672
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-338-1324
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1729 ALAMO AVE
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80907-7307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-338-1324
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. CHRISTOPHER NORMAN TULIN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 719-338-1324
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 28056
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------