Provider Demographics
NPI:1467865253
Name:JUSTIN BULS
Entity Type:Organization
Organization Name:JUSTIN BULS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BULS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-751-8113
Mailing Address - Street 1:1035 1ST AVE W.
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901
Mailing Address - Country:US
Mailing Address - Phone:406-751-8113
Mailing Address - Fax:406-758-2169
Practice Address - Street 1:1035 1ST AVE W.
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901
Practice Address - Country:US
Practice Address - Phone:406-751-8113
Practice Address - Fax:406-758-2169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-09
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT11703207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000084267Medicare PIN