Healthcare Provider Details

I. General information

NPI: 1023034519
Provider Name (Legal Business Name): ANDREW J BULLA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 N MARR RD SUITE C
COLUMBUS IN
47201-2610
US

IV. Provider business mailing address

2360 S 950 E
ZIONSVILLE IN
46077-8680
US

V. Phone/Fax

Practice location:
  • Phone: 812-376-9353
  • Fax: 812-376-3757
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number10000859A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: