Provider Demographics
NPI:1033522784
Name:BULTSMA, BRANDON (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:
Last Name:BULTSMA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3558 ROOKWOOD PL
Mailing Address - Street 2:
Mailing Address - City:JOHNS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29455-8183
Mailing Address - Country:US
Mailing Address - Phone:854-444-3129
Mailing Address - Fax:
Practice Address - Street 1:1565 SAM RITTENBERG BLVD STE 104
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4128
Practice Address - Country:US
Practice Address - Phone:854-444-3129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC707213ES0103X
MI5901002526213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery