Provider Demographics
NPI:1710913256
Name:BULBUL, RULA (MD)
Entity Type:Individual
Prefix:
First Name:RULA
Middle Name:
Last Name:BULBUL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 GORDONVILLE RD
Mailing Address - Street 2:STE 301
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-5056
Mailing Address - Country:US
Mailing Address - Phone:573-334-9641
Mailing Address - Fax:573-331-3120
Practice Address - Street 1:3250 GORDONVILLE RD
Practice Address - Street 2:STE 301
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5056
Practice Address - Country:US
Practice Address - Phone:573-334-9641
Practice Address - Fax:573-331-3120
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2002009347207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOH62676Medicare UPIN