Individual
JOHN WALTER BULGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
303 S MAIN ST, SUITE 200, MISHAWAKA, IN 46544-2189
(574) 255-8285
(574) 255-8341
Mailing address
303 S MAIN ST, SUITE 200, MISHAWAKA, IN 46544-2189
(574) 255-8285
(574) 255-8341
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01034598A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100091420A
—
IN
Enumeration date
02/21/2007
Last updated
01/15/2010
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