Individual
MICHAEL J. TULLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3875 E OVERLAND RD STE 2D, MERIDIAN, ID 83642-9005
(208) 600-1550
(208) 600-1551
Mailing address
3875 E OVERLAND RD STE 2D, MERIDIAN, ID 83642-9005
(208) 600-1550
(208) 600-1551
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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