Individual
GREGORY BULLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5666 EAST STATE ST, ROCKFORD, IL 61108-2472
(815) 226-2000
(815) 381-7582
Mailing address
5666 EAST STATE ST, ROCKFORD, IL 61108-2472
(815) 226-2000
(815) 381-7582
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
036067306
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36067306
—
IL
Enumeration date
07/01/2006
Last updated
11/01/2013
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