Provider Demographics
NPI:1083655047
Name:EMANUELE, TULLIO (MD)
Entity Type:Individual
Prefix:MR
First Name:TULLIO
Middle Name:
Last Name:EMANUELE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 808
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42102-0808
Mailing Address - Country:US
Mailing Address - Phone:270-904-0657
Mailing Address - Fax:270-904-1746
Practice Address - Street 1:427 US 31W BYP
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1703
Practice Address - Country:US
Practice Address - Phone:270-904-0657
Practice Address - Fax:270-904-1746
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYMD39597207RI0011X
KY39597207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64127251Medicaid
F69125Medicare UPIN
1966401Medicare PIN