MEDICARE: DR. ANGELA BULLY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	4301057665	MI

General Provider Information

NPI Number	:	1841257029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGELA BULLY M.D.

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

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

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2006
Last Update Date	:	07/08/2007

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