Provider Demographics
NPI:1205630100
Name:BULKLEY, MATTHEW BROOKS (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:BROOKS
Last Name:BULKLEY
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 N VINEYARD RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-1348
Mailing Address - Country:US
Mailing Address - Phone:435-429-9930
Mailing Address - Fax:
Practice Address - Street 1:19000 ST JOES PKWY STE 310
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1477
Practice Address - Country:US
Practice Address - Phone:734-743-4540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program