Provider Demographics
NPI:1689012502
Name:BULMASH, MARY ELLEN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MARY ELLEN
Middle Name:
Last Name:BULMASH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:KANSAS UNIVERSITY PHYSICIANS INC
Mailing Address - Street 2:3901 RAINBOW BLVD. MAILSTOP 2028
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160-0001
Mailing Address - Country:US
Mailing Address - Phone:913-588-6268
Mailing Address - Fax:913-945-8524
Practice Address - Street 1:KANSAS UNIVERSITY PHYSICIANS INC
Practice Address - Street 2:3901 RAINBOW BLVD. MAILSTOP 2028
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-0001
Practice Address - Country:US
Practice Address - Phone:913-588-6268
Practice Address - Fax:913-945-8524
Is Sole Proprietor?:No
Enumeration Date:2013-06-13
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00345363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant