Provider Demographics
NPI:1457554750
Name:TULLIO EMANUELE MD, PSC
Entity Type:Organization
Organization Name:TULLIO EMANUELE MD, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TULLIO
Authorized Official - Middle Name:
Authorized Official - Last Name:EMANUELE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-782-6964
Mailing Address - Street 1:720 SECOND STREET
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-5852
Mailing Address - Country:US
Mailing Address - Phone:270-782-6964
Mailing Address - Fax:270-782-6988
Practice Address - Street 1:720 SECOND STREET
Practice Address - Street 2:SUITE 204
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-5852
Practice Address - Country:US
Practice Address - Phone:270-782-6964
Practice Address - Fax:270-782-6988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39597207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9876Medicare ID - Type Unspecified
KYF69125Medicare UPIN