Healthcare Provider Details

I. General information

NPI: 1467678623
Provider Name (Legal Business Name): JUSTIN BULS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 03/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 1ST AVE W
KALISPELL MT
59901-5607
US

IV. Provider business mailing address

1035 1ST AVE W
KALISPELL MT
59901-5607
US

V. Phone/Fax

Practice location:
  • Phone: 406-751-8113
  • Fax: 406-751-8148
Mailing address:
  • Phone: 406-751-8113
  • Fax: 406-751-8148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11703
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: