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General NPI Number Information
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NPI Number | 1780144329
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Entity Type | Individual
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Provider Name | DR. KEITH WILLIAM BULLINGER
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Gender | Male
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Dates
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Enumeration Date | 03/20/2019
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Last Update Date | 03/12/2025
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Provider Practice Location Address
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Address Line | 7435 SISTERS GRV STE 100
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City | COLORADO SPRINGS
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State | CO
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Zip | 80923-2628
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Country | US
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Telephone | 719-960-0363
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 88143
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City | CHICAGO
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State | IL
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Zip | 60680-1143
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Country | US
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Telephone | 719-445-7544
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Fax |
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 39145
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | DR.0074193
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License Number State | CO
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