Healthcare Provider Details

I. General information

NPI: 1518160456
Provider Name (Legal Business Name): CHRISTIAN BULCAO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 06/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2028 MADISON RD APT 2
CINCINNATI OH
45208-3261
US

IV. Provider business mailing address

2028 MADISON RD APT 2
CINCINNATI OH
45208-3261
US

V. Phone/Fax

Practice location:
  • Phone: 513-255-7312
  • Fax:
Mailing address:
  • Phone: 513-255-7312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number57006568
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number35.093826
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35.093826
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: