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General NPI Number Information
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NPI Number | 1922215201
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Entity Type | Organization
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Legal Business Name | ANGELA BULLY M.D., P.L.L.C.
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 11/02/2009
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Provider Practice Location Address
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Address Line | 4160 JOHN R ST SUITE 804
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City | DETROIT
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State | MI
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Zip | 48201-2020
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Country | US
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Telephone | 313-833-1271
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Fax | 313-833-1273
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Provider Business Mailing Address
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Address Line | 4160 JOHN R ST SUITE 804
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City | DETROIT
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State | MI
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Zip | 48201-2020
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Country | US
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Telephone | 313-833-1271
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Fax | 313-833-1273
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | DR. ANGELA BULLY
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Credential | M.D.
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Telephone | 313-833-1271
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301057665
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License Number State | MI
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