Provider Demographics
NPI:1811083009
Name:TOMBULOGLU, BEDRIYE Y (MD)
Entity type:Individual
Prefix:DR
First Name:BEDRIYE
Middle Name:Y
Last Name:TOMBULOGLU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4325 S 60TH ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220
Mailing Address - Country:US
Mailing Address - Phone:414-545-5500
Mailing Address - Fax:414-545-5335
Practice Address - Street 1:4325 S 60TH ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220
Practice Address - Country:US
Practice Address - Phone:414-545-5500
Practice Address - Fax:414-545-5335
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI52D0391395207ZP0105X
WI21422020208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D3D4RCMedicare UPIN