Healthcare Provider Details

I. General information

NPI: 1578152708
Provider Name (Legal Business Name): PATRICK D PULLUM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2021
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233 WATKINS AVE
AKRON OH
44305-2019
US

IV. Provider business mailing address

PO BOX 290
TALLMADGE OH
44278-0290
US

V. Phone/Fax

Practice location:
  • Phone: 234-788-4293
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: