Basic Information
| Provider Information | |||||||||
| NPI: | 1508131301 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VALENTYN TYULMENKOV LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 263 NW 70TH ST | ||||||||
| Address2: | |||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334872392 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613029515 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7300 DEL PRADO CIR S | ||||||||
| Address2: | |||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334333386 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613923000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2012 | ||||||||
| LastUpdateDate: | 05/29/2012 | ||||||||
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| AuthorizedOfficialLastName: | TYULMENKOV | ||||||||
| AuthorizedOfficialFirstName: | VALENTYN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5613029515 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME111260 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 004647400 | 05 | FL | MEDICAID |