Provider Demographics
NPI:1891859856
Name:BULL, MINDI MARIE (DO)
Entity Type:Individual
Prefix:
First Name:MINDI
Middle Name:MARIE
Last Name:BULL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:800 W BOISE CIR
Mailing Address - Street 2:STE 150
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-4906
Mailing Address - Country:US
Mailing Address - Phone:918-994-9150
Mailing Address - Fax:918-403-6323
Practice Address - Street 1:800 W BOISE CIR
Practice Address - Street 2:STE 150
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-4906
Practice Address - Country:US
Practice Address - Phone:918-994-9150
Practice Address - Fax:918-403-6323
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK4384207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200101160AMedicaid
OK200101160AMedicaid
OK317052YK76Medicare PIN