Provider Demographics
NPI:1164599635
Name:PULS, MARK WILFRED (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:WILFRED
Last Name:PULS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:311 LONG RAPIDS PLZ
Mailing Address - Street 2:PO BOX 535
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-1375
Mailing Address - Country:US
Mailing Address - Phone:989-354-5717
Mailing Address - Fax:989-356-6526
Practice Address - Street 1:311 LONG RAPIDS PLZ
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-1375
Practice Address - Country:US
Practice Address - Phone:989-354-5717
Practice Address - Fax:989-356-6526
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301403324208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3396665Medicaid
MI0041029OtherBLUE CROSS PIN
MI3070608Medicaid
MI3396683Medicaid
MIP22040002Medicare PIN
MI3396683Medicaid