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General NPI Number Information
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NPI Number | 1447473780
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Entity Type | Organization
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Legal Business Name | JOHN W. BULGER M.D. P.C.
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 303 S MAIN ST SUITE 200
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City | MISHAWAKA
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State | IN
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Zip | 46544-2189
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Country | US
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Telephone | 574-255-8285
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Fax | 574-255-8341
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Provider Business Mailing Address
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Address Line | 303 S MAIN ST SUITE 200
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City | MISHAWAKA
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State | IN
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Zip | 46544-2189
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Country | US
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Telephone | 574-255-8285
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Fax | 574-255-8341
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN WALTER BULGER
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Credential | M.D.
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Telephone | 574-255-8285
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01034598A
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License Number State | IN
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