Provider Demographics
NPI:1437459237
Name:KULKARNI, TANMAY AJAY (PT)
Entity Type:Individual
Prefix:MR
First Name:TANMAY
Middle Name:AJAY
Last Name:KULKARNI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20245 W 12 MILE RD
Mailing Address - Street 2:STE 100
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-5409
Mailing Address - Country:US
Mailing Address - Phone:248-569-5410
Mailing Address - Fax:
Practice Address - Street 1:20245 W 12 MILE RD
Practice Address - Street 2:STE 100
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-5409
Practice Address - Country:US
Practice Address - Phone:248-569-5410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015184225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist