MEDICARE: DR. ERICK C BULAWA 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	207RB0002X	Obesity Medicine (Internal Medicine) Physician	179208	TN
2	208000000X	Pediatrics Physician	179208	TN
3	207R00000X	Internal Medicine Physician	179208	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P01237829	OTHER	TN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	4357373	OTHER	TN	BCBST

General Provider Information

NPI Number	:	1326020199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERICK C BULAWA M.D.

Provider Business Mailing Address
First Line	:	1021 W OAKLAND AVE STE 310
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-2192
Country	:	US
Telephone Number	:	423-302-6565
Fax Number	:

Provider Business Practice Location Address
First Line	:	438 E VANN RD STE 201
Second Line	:
City	:	GREENEVILLE
State	:	TN
Zip	:	37743-7202
Country	:	US
Telephone Number	:	423-278-1800
Fax Number	:	423-278-1805

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

Provider Enumeration Date	:	11/17/2005
Last Update Date	:	11/14/2023

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Directions to “ DR. ERICK C BULAWA M.D.” Practice Location

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