1922215201 NPI number — ANGELA BULLY M.D., P.L.L.C.

Table of content: (NPI 1922215201)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922215201 NPI number — ANGELA BULLY M.D., P.L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANGELA BULLY M.D., P.L.L.C.
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:
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:
1922215201
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4160 JOHN R ST
Provider Second Line Business Mailing Address:
SUITE 804
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48201-2020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-833-1271
Provider Business Mailing Address Fax Number:
313-833-1273

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4160 JOHN R ST
Provider Second Line Business Practice Location Address:
SUITE 804
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48201-2020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-833-1271
Provider Business Practice Location Address Fax Number:
313-833-1273
Provider Enumeration Date:
05/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BULLY
Authorized Official First Name:
ANGELA
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN OWNER
Authorized Official Telephone Number:
313-833-1271

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  4301057665 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 104357008 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1841257029 . This is a "INDIVIDUAL NPI #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4301084811 . This is a "PROVIDER LICENSE #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P61277 . This is a "BLUE CARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1108235671 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1366536088 . This is a "INDIVIDUAL NPI #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4301057665 . This is a "PROVIDER LICENSE #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com