Provider Demographics
NPI:1780144329
Name:BULLINGER, KEITH WILLIAM
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:WILLIAM
Last Name:BULLINGER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 88143
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60680-1143
Mailing Address - Country:US
Mailing Address - Phone:719-445-7544
Mailing Address - Fax:
Practice Address - Street 1:7435 SISTERS GRV STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-2628
Practice Address - Country:US
Practice Address - Phone:719-960-0363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK39145207RC0000X
CODR.0074193207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease