Individual
DR. JACK M BULMASH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5000 S 5TH AVE, HINES, IL 60141-3030
(708) 202-5636
(312) 951-1488
Mailing address
5000 S. 5TH AVE., BLD.1 HINES VA HOSPITAL, HINES, IL 60141-3030
(708) 202-5636
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
03644313
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036044313
—
IL
Enumeration date
01/09/2006
Last updated
07/19/2010
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