Healthcare Provider Details

I. General information

NPI: 1093844391
Provider Name (Legal Business Name): ROBERT ELLIOTT BULANDER JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2007
Last Update Date: 10/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 JACKSON ST MAIL STOP 11502V
SAINT PAUL MN
55101-2502
US

IV. Provider business mailing address

640 JACKSON ST MAIL STOP 11502V
SAINT PAUL MN
55101-2502
US

V. Phone/Fax

Practice location:
  • Phone: 651-254-3136
  • Fax: 651-254-1480
Mailing address:
  • Phone: 651-254-3136
  • Fax: 651-254-1480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number48345
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number48345
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number48345
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: