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NPI Code Detail

MEDICARE: STEPHEN R LULL M.D.

MEDICARE: STEPHEN R LULL 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
1208000000XPediatrics PhysicianSL033924MI

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 : 1952371593
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHEN R LULL M.D.
Provider Business Mailing Address
First Line : 670 MALL DR
Second Line :
City : PORTAGE
State : MI
Zip : 49024-2878
Country : US
Telephone Number : 269-327-1900
Fax Number : 269-327-1564
Provider Business Practice Location Address
First Line : 670 MALL DR
Second Line :
City : PORTAGE
State : MI
Zip : 49024-2878
Country : US
Telephone Number : 269-327-1900
Fax Number : 269-327-1564
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2006
Last Update Date : 07/08/2007

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Directions to “ STEPHEN R LULL M.D.” Practice Location

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