Provider Demographics
NPI:1811975196
Name:TULI, KASTURI (MD)
Entity type:Individual
Prefix:DR
First Name:KASTURI
Middle Name:
Last Name:TULI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1669 W INA RD STE 101
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-1976
Mailing Address - Country:US
Mailing Address - Phone:520-573-0966
Mailing Address - Fax:520-784-7226
Practice Address - Street 1:1669 W INA RD STE 141
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1981
Practice Address - Country:US
Practice Address - Phone:520-795-6183
Practice Address - Fax:520-795-6361
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32151207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZC38812Medicare UPIN
AZ103480Medicare ID - Type Unspecified