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NPI Code Detail

MEDICARE: BRENNA BULLOCK

MEDICARE: BRENNA BULLOCK
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
1207W00000XOphthalmology PhysicianR78566AZ

General Provider Information

NPI Number : 1952983801
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRENNA BULLOCK
Provider Business Mailing Address
First Line : 45615 FREEMONT
Second Line :
City : NOVI
State : MI
Zip : 48374-3132
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 655 N ALVERNON WAY STE 204
Second Line :
City : TUCSON
State : AZ
Zip : 85711-1825
Country : US
Telephone Number : 248-444-5331
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/21/2021
Last Update Date : 08/02/2023

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Directions to “ BRENNA BULLOCK ” Practice Location

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