1013714054 NPI number — PAUL H BULLER MD

Table of content: MRS. SHRADDHA ADHIKARI TEFFT B.S. (NPI 1174701130)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013714054 NPI number — PAUL H BULLER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAUL H BULLER MD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013714054
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/26/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1302 COLLEGE AVE STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GOSHEN
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46526-4939
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-534-4880
Provider Business Mailing Address Fax Number:
574-534-4868

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1302 COLLEGE AVE STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GOSHEN
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46526-4939
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-534-4880
Provider Business Practice Location Address Fax Number:
574-534-4868
Provider Enumeration Date:
02/27/2025

Additional Information

Authorized Official

Authorized Official Last Name:
BULLER
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
574-534-4880

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , registered in the state of NULL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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