Provider Demographics
NPI:1558834788
Name:TULJUS, JAMES J (PA C)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:J
Last Name:TULJUS
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6288 N 88TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:HART
Mailing Address - State:MI
Mailing Address - Zip Code:49420
Mailing Address - Country:US
Mailing Address - Phone:248-245-3023
Mailing Address - Fax:
Practice Address - Street 1:1180 NEWFIELD AVE
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-1409
Practice Address - Country:US
Practice Address - Phone:314-888-5233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-10
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601008946363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
5315096411OtherLISCENSE
MI5315230075OtherSTATE OF MICHIGAN CONTROLLED SUBSTANCE LICENSE
MI5601008946OtherSTATE OF MICHIGAN PHYSICIAN ASSISTANT LICENSE
MI5315230075OtherSTATE OF MICHIGAN CONTROLLED SUBSTANCE LICENSE