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Individual
MICHAEL J. TULLIS
Active
Individual
MICHAEL J. TULLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
M-7939
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010028313
BLUE SHIELD
ID
05
—
288349
—
OR
01
—
770002414
RRMC
ID
05
—
805714900
—
ID
01
—
J3938
BLUE CROSS
ID
Enumeration date
05/16/2006
Last updated
10/09/2019
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