Provider Demographics
NPI:1881743821
Name:LUTFI T TOMBULOGLU MD SC
Entity type:Organization
Organization Name:LUTFI T TOMBULOGLU MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BEDRIYE
Authorized Official - Middle Name:
Authorized Official - Last Name:TOMBULOGLU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-545-5500
Mailing Address - Street 1:4325 S 60TH ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-3508
Mailing Address - Country:US
Mailing Address - Phone:414-545-5500
Mailing Address - Fax:414-545-5335
Practice Address - Street 1:4325 S 60TH ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-3508
Practice Address - Country:US
Practice Address - Phone:414-545-5500
Practice Address - Fax:414-545-5335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17161-020261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30966100Medicaid
WIB85315Medicare UPIN
WI30966100Medicaid