=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922126275
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KARAMJIT SINGH BHULLAR MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2007
-----------------------------------------------------
Last Update Date | 05/23/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 155 5TH ST NE
-----------------------------------------------------
City | BARBERTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44203-3332
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-615-3000
-----------------------------------------------------
Fax | 330-615-3250
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 708790
-----------------------------------------------------
City | SANDY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84070-8790
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-869-2395
-----------------------------------------------------
Fax | 801-352-9502
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 89102
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------