Provider Demographics
NPI:1770985921
Name:SULKOWSKI FAMILY MEDICINE, PLLC
Entity type:Organization
Organization Name:SULKOWSKI FAMILY MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DANNETTA
Authorized Official - Middle Name:K
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-900-1381
Mailing Address - Street 1:1810 WARD DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-0560
Mailing Address - Country:US
Mailing Address - Phone:615-900-1381
Mailing Address - Fax:615-900-1388
Practice Address - Street 1:1810 WARD DR
Practice Address - Street 2:SUITE 101
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-0560
Practice Address - Country:US
Practice Address - Phone:615-900-1381
Practice Address - Fax:615-900-1388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20465207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNE37745Medicare UPIN