Provider Demographics
NPI:1275891293
Name:BULAU, CASSANDRA JEWELS (MD)
Entity Type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:JEWELS
Last Name:BULAU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 S ARMSTRONG AVE
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55355-3004
Mailing Address - Country:US
Mailing Address - Phone:320-693-7472
Mailing Address - Fax:
Practice Address - Street 1:520 S SIBLEY AVE
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55355-3030
Practice Address - Country:US
Practice Address - Phone:320-693-3233
Practice Address - Fax:320-693-3290
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-27
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN56498207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine