Healthcare Provider Details

I. General information

NPI: 1841726932
Provider Name (Legal Business Name): SIDRA B BHULLER D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2017
Last Update Date: 07/12/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 E MICHIGAN AVE STE 300
LANSING MI
48912-1806
US

IV. Provider business mailing address

1140 E MICHIGAN AVE STE 300
LANSING MI
48912-1806
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-5200
  • Fax:
Mailing address:
  • Phone: 517-364-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number5101026829
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: