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General NPI Number Information
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NPI Number | 1023542842
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Entity Type | Individual
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Provider Name | JOHN BULKO
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Gender | Male
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Dates
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Enumeration Date | 04/18/2017
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Last Update Date | 04/30/2021
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Provider Practice Location Address
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Address Line | 140 MICHIGAN AVE W
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City | BATTLE CREEK
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State | MI
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Zip | 49017-3602
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Country | US
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Telephone | 269-966-1460
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Fax | 269-966-2844
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Provider Business Mailing Address
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Address Line | 2700 E CENTRE AVE
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City | PORTAGE
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State | MI
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Zip | 49002-5500
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Country | US
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Telephone | 269-286-7050
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Fax | 269-286-7051
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6801097124
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801106731
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License Number State | MI
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