Provider Demographics
NPI:1023034519
Name:BULLA, ANDREW J (PA-C)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
Last Name:BULLA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2360 S 950 E
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-8680
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:940 N MARR RD
Practice Address - Street 2:SUITE C
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-2610
Practice Address - Country:US
Practice Address - Phone:812-376-9353
Practice Address - Fax:812-376-3757
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000859A363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN186780Medicare PIN
IN4207900005Medicare NSC
IN179050LMedicare PIN