Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 4301059424 | MI |
NPI | 1043202948 |
---|---|
Provider Name | Dr. Usha Kurumety Bulusu |
First Address | Saginaw, MI 48604-9596 |
Second Address | Saginaw, MI 48604-9596 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2005 |
Last Update Date | 07/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4508443 10 | (05) | MI |
G37263 | (02) | MI |