Provider Demographics
NPI:1952381600
Name:OKULSKI, THOMAS (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:OKULSKI
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 1:1395 S PINELLAS AVE
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-3790
Mailing Address - Country:US
Mailing Address - Phone:941-624-7032
Mailing Address - Fax:
Practice Address - Street 1:4300 N ACCESS RD
Practice Address - Street 2:SUITE D
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37415-3812
Practice Address - Country:US
Practice Address - Phone:423-826-1276
Practice Address - Fax:423-826-1290
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME-00270522085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D82412Medicare UPIN
FL29940TMedicare ID - Type UnspecifiedFLORIDA MEDICARE