Provider Demographics
NPI:1548269178
Name:TYULMENKOV, VALENTYN (MD)
Entity type:Individual
Prefix:MR
First Name:VALENTYN
Middle Name:
Last Name:TYULMENKOV
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 1:263 NW 70TH ST
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-2392
Mailing Address - Country:US
Mailing Address - Phone:561-302-9515
Mailing Address - Fax:
Practice Address - Street 1:263 NW 70TH ST
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-2392
Practice Address - Country:US
Practice Address - Phone:561-302-9515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2012-03-14
Deactivation Date:2006-03-18
Deactivation Code:
Reactivation Date:2006-03-21
Provider Licenses
StateLicense IDTaxonomies
KY38490208M00000X
FLME111260208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64083363Medicaid
KY00265003Medicare PIN
KY00728001Medicare PIN
I10440Medicare UPIN