Provider Demographics
NPI:1255413852
Name:BULA, MELANIA LIZA (MD)
Entity type:Individual
Prefix:
First Name:MELANIA
Middle Name:LIZA
Last Name:BULA
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 1:3695 GREEN RD
Mailing Address - Street 2:UNIT 22778
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-7939
Mailing Address - Country:US
Mailing Address - Phone:330-655-1869
Mailing Address - Fax:330-655-3828
Practice Address - Street 1:725 WELCH RD
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1601
Practice Address - Country:US
Practice Address - Phone:650-497-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.00489922085P0229X
NC2005-001432085P0229X
CAA1113022085R0202X, 2085P0229X
NC2005001432085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3696645000OtherPASSPORT ADVANTAGE
KY50022545OtherPASSPORT
KY7100068810Medicaid
KY00533101OtherMEDICARE
NC5900259,Medicaid
IN200932060Medicaid
NC5900259,Medicaid
IN200932060Medicaid