Provider Demographics
NPI:1518160456
Name:BULCAO, CHRISTIAN (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:
Last Name:BULCAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2028 MADISON RD
Mailing Address - Street 2:APT 2
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45208-3261
Mailing Address - Country:US
Mailing Address - Phone:513-255-7312
Mailing Address - Fax:
Practice Address - Street 1:2028 MADISON RD
Practice Address - Street 2:APT 2
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45208-3261
Practice Address - Country:US
Practice Address - Phone:513-255-7312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57006568208600000X
OH35.0938262086S0102X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH023740Medicare PIN