Organization
ANGELA BULLY M.D., P.L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANGELA BULLY M.D. (PHYSICIAN OWNER)
(313) 833-1271
Entity
Organization
Contact information
Practice address
4160 JOHN R ST, SUITE 804, DETROIT, MI 48201-2020
(313) 833-1271
(313) 833-1273
Mailing address
4160 JOHN R ST, SUITE 804, DETROIT, MI 48201-2020
(313) 833-1271
(313) 833-1273
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301057665
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104357008
—
MI
01
—
1108235671
BLUE CROSS BLUE SHIELD
MI
01
—
1366536088
INDIVIDUAL NPI #
MI
01
—
1841257029
INDIVIDUAL NPI #
MI
01
—
4301057665
PROVIDER LICENSE #
MI
01
—
4301084811
PROVIDER LICENSE #
MI
01
—
P61277
BLUE CARE NETWORK
MI
Enumeration date
05/17/2007
Last updated
11/02/2009
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