# BRANDON C BULTSMA, DPM, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659952133
- **Authorized official:** BRANDON BULTSMA DPM (OWNER/PRESIDENT)
- **Authorized official phone:** (854) 444-3129

## Contact information

- **Practice address:** 1565 SAM RITTENBERG BLVD STE 104, CHARLESTON, SC 29407-4128
- **Practice address phone:** (854) 444-3129
- **Practice address fax:** (854) 444-3190
- **Mailing address:** 1565 SAM RITTENBERG BLVD STE 104, CHARLESTON, SC 29407-4128
- **Mailing address phone:** (854) 444-3129
- **Mailing address fax:** (854) 444-3190

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | NULL | Yes |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | — | Yes |

## Other

- **Enumeration date:** 04/16/2021
- **Last updated:** 02/14/2024