Provider Demographics
NPI:1841619384
Name:BULZOMI, MONTY
Entity Type:Individual
Prefix:
First Name:MONTY
Middle Name:
Last Name:BULZOMI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3202 OLD HIGHWAY 8
Mailing Address - Street 2:
Mailing Address - City:ST ANTHONY
Mailing Address - State:MN
Mailing Address - Zip Code:55418-2585
Mailing Address - Country:US
Mailing Address - Phone:701-653-5951
Mailing Address - Fax:
Practice Address - Street 1:3202 OLD HIGHWAY 8
Practice Address - Street 2:
Practice Address - City:ST ANTHONY
Practice Address - State:MN
Practice Address - Zip Code:55418-2585
Practice Address - Country:US
Practice Address - Phone:701-653-5951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-14
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program