Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | PB064047 | MI |
Y | 208600000X | Surgeon | PB064047 | MI |
NPI | 1003813668 |
---|---|
Provider Name | Patrick P Bulinski |
First Address | Marquette, MI 49855-2675 |
Second Address | Marquette, MI 49855-2675 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2005 |
Last Update Date | 23/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0E26017 | BLUE CROSS/BLUE SHIELD (01) | MI |
4117101 | (05) | MI |
4227101 | (05) | MI |
H16469 | (02) | |
H16469 | (02) | MI |