Provider Demographics
NPI:1427009166
Name:PULS, MARY ELLEN (DO)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELLEN
Last Name:PULS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36539 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-2012
Mailing Address - Country:US
Mailing Address - Phone:586-792-8877
Mailing Address - Fax:586-792-8876
Practice Address - Street 1:36333 HARPER AVE
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48035-2958
Practice Address - Country:US
Practice Address - Phone:586-792-8877
Practice Address - Fax:586-792-8876
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMP008465207R00000X
MI5101008465207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3156767Medicaid
MI3156767Medicaid
MIE26399Medicare UPIN