Provider Demographics
NPI:1750905238
Name:BHULLAR, JAIBIR (MD)
Entity type:Individual
Prefix:
First Name:JAIBIR
Middle Name:
Last Name:BHULLAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1200 E MICHIGAN AVE STE 245
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-1897
Mailing Address - Country:US
Mailing Address - Phone:517-364-5710
Mailing Address - Fax:517-364-5717
Practice Address - Street 1:13191 SCHAVEY RD STE 3
Practice Address - Street 2:
Practice Address - City:DEWITT
Practice Address - State:MI
Practice Address - Zip Code:48820-9036
Practice Address - Country:US
Practice Address - Phone:517-669-9109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301509727207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine