MEDICARE: ADITYA D. BULUSU MD

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	208800000X	Urology Physician	AB076885	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	340019505	OTHER	MI	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	340019505	OTHER	MI	TRI CARE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0990537	OTHER	MI	HEALTHPLUS-BAY
4	0990461	OTHER	MI	HEALTHPLUS-SAGINAW
5	340G310500	OTHER	MI	BLUE CROSS
6	5272733	OTHER	MI	AETNA

General Provider Information

NPI Number	:	1982697074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADITYA D. BULUSU MD

Provider Business Mailing Address
First Line	:	1117 S WASHINGTON AVE
Second Line	:
City	:	SAGINAW
State	:	MI
Zip	:	48601-2558
Country	:	US
Telephone Number	:	989-791-4020
Fax Number	:	989-921-8765

Provider Business Practice Location Address
First Line	:	1117 S WASHINGTON AVE
Second Line	:
City	:	SAGINAW
State	:	MI
Zip	:	48601-2558
Country	:	US
Telephone Number	:	989-791-4020
Fax Number	:	989-921-8765

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

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	09/20/2023

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Directions to “ ADITYA D. BULUSU MD” Practice Location

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