MEDICARE: BULU HALDER

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	253J00000X	Foster Care Agency	AF110380663	MI

General Provider Information

NPI Number	:	1598453649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BULU HALDER

Provider Business Mailing Address
First Line	:	1637 COLFAX AVE
Second Line	:
City	:	BENTON HARBOR
State	:	MI
Zip	:	49022-7354
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1637 COLFAX AVE
Second Line	:
City	:	BENTON HARBOR
State	:	MI
Zip	:	49022-7354
Country	:	US
Telephone Number	:	269-927-2680
Fax Number	:

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

Provider Enumeration Date	:	04/26/2023
Last Update Date	:	04/26/2023

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Directions to “ BULU HALDER ” Practice Location

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