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NPI Code Detail

MEDICARE: DR. JACK M BULMASH M.D.

MEDICARE: DR. JACK M BULMASH 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
1207RG0300XGeriatric Medicine (Internal Medicine) Physician03644313IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1700864725
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JACK M BULMASH M.D.
Provider Business Mailing Address
First Line : 5000 S. 5TH AVE.
Second Line : BLD.1 HINES VA HOSPITAL
City : HINES
State : IL
Zip : 60141-3030
Country : US
Telephone Number : 708-202-5636
Fax Number :
Provider Business Practice Location Address
First Line : 5000 S 5TH AVE
Second Line :
City : HINES
State : IL
Zip : 60141-3030
Country : US
Telephone Number : 708-202-5636
Fax Number : 312-951-1488
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/09/2006
Last Update Date : 07/19/2010

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