Provider Demographics
NPI:1346537289
Name:PULLUKAT, ROY J (MD)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:J
Last Name:PULLUKAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:44200 WOODWARD AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-5045
Mailing Address - Country:US
Mailing Address - Phone:248-253-9600
Mailing Address - Fax:
Practice Address - Street 1:44200 WOODWARD AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5045
Practice Address - Country:US
Practice Address - Phone:248-253-9600
Practice Address - Fax:248-253-0980
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301099218208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics