Individual
REBECCA L BULTMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
100 MICHIGAN ST NE, ROOM 280, GRAND RAPIDS, MI 49503-2560
(616) 391-5275
(616) 391-8848
Mailing address
100 MICHIGAN ST NE, MC 845, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
4301065600
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0410823
BCBSM
MI
01
—
1558407189
GROUP NPI
MI
05
—
3516825
—
MI
Enumeration date
02/01/2006
Last updated
07/18/2025
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