MEDICARE: MR. TANMAY AJAY KULKARNI PT

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	225100000X	Physical Therapist	5501015184	MI

General Provider Information

NPI Number	:	1437459237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TANMAY AJAY KULKARNI PT

Provider Business Mailing Address
First Line	:	20245 W 12 MILE RD
Second Line	:	STE 100
City	:	SOUTHFIELD
State	:	MI
Zip	:	48076-5409
Country	:	US
Telephone Number	:	248-569-5410
Fax Number	:

Provider Business Practice Location Address
First Line	:	20245 W 12 MILE RD
Second Line	:	STE 100
City	:	SOUTHFIELD
State	:	MI
Zip	:	48076-5409
Country	:	US
Telephone Number	:	248-569-5410
Fax Number	:

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

Provider Enumeration Date	:	10/26/2010
Last Update Date	:	10/26/2010

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