MEDICARE: DR. MANUEL EVANGELOS BULAUITAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	2019-01401	NC
2	207Q00000X	Family Medicine Physician	17549	NH

General Provider Information

NPI Number	:	1316226442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MANUEL EVANGELOS BULAUITAN M.D.

Provider Business Mailing Address
First Line	:	10900 WORLD TRADE BLVD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27617-4202
Country	:	US
Telephone Number	:	919-237-1337
Fax Number	:

Provider Business Practice Location Address
First Line	:	1964 S MAIN ST
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587
Country	:	US
Telephone Number	:	919-554-0177
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2011
Last Update Date	:	05/28/2019

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