Individual
JILL BULTJE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1471 E BELTLINE AVE NE, SUITE 201, GRAND RAPIDS, MI 49525-4548
(616) 685-8620
(676) 447-7674
Mailing address
245 STATE ST SE, GRAND RAPIDS, MI 49503-4328
(616) 685-1808
(616) 685-1850
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301074566
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4440300
—
MI
05
—
4440310
—
MI
05
—
4440329
—
MI
05
—
4440338
—
MI
05
—
4440347
—
MI
05
—
4548162
—
MI
05
—
4876996
—
MI
Enumeration date
05/17/2006
Last updated
06/26/2009
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