Individual
ELIZA BULLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
22 BRAMHALL ST, PORTLAND, ME 04102-3134
(207) 662-4618
(207) 662-6254
Mailing address
300 SOUTHBOROUGH DR, SUITE 201, SOUTH PORTLAND, ME 04106-6914
(207) 661-2000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
54149
CT
207R00000X
Internal Medicine Physician
Primary
MD21138
ME
208000000X
Pediatrics Physician
54149
CT
208000000X
Pediatrics Physician
MD21138
ME
Other
Enumeration date
04/11/2011
Last updated
08/18/2016
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