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Individual

DR. KENT BULLIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
110 HO PLZ, ITHACA, NY 14853-3102
(607) 255-5155
Mailing address
110 HO PLZ, ITHACA, NY 14853-3102

Taxonomy

Speciality
Code
Description
License number
State
207QA0000X
Adolescent Medicine (Family Medicine) Physician
Primary
1034097
IN

Other

Enumeration date
09/28/2006
Last updated
09/26/2013
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