Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 41040 | WI |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 41040 | WI |
NPI | 1184633869 |
---|---|
Provider Name | Paul V Bullis |
First Address | Milwaukee, WI 53209-2042 |
Second Address | Hartford, WI 53027 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 29/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
32557200 | (05) | WI |
G66650 | (02) | |
P00941428 | RR MEDICARE (01) | WY |