Provider Demographics
NPI:1225089964
Name:TYULUMAN, SAMUEL ALEXANDER (MD)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:ALEXANDER
Last Name:TYULUMAN
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 1:9301 N CENTRAL EXPY
Mailing Address - Street 2:SUITE 475
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-0806
Mailing Address - Country:US
Mailing Address - Phone:214-368-3755
Mailing Address - Fax:214-368-3758
Practice Address - Street 1:9301 N CENTRAL EXPY
Practice Address - Street 2:SUITE 475
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-0806
Practice Address - Country:US
Practice Address - Phone:214-368-3755
Practice Address - Fax:214-368-3758
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2855174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH2855OtherSTATE LICENSE
TX122815701Medicaid
TX88414ZOtherBLUE CROSS/BLUE SHIELD
TX00D24XMedicare PIN
TXE35388Medicare UPIN