Provider Demographics
NPI:1801871975
Name:BULL, MARILYN JEAN (MD)
Entity type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:JEAN
Last Name:BULL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1026
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-1026
Mailing Address - Country:US
Mailing Address - Phone:317-777-6435
Mailing Address - Fax:317-777-6644
Practice Address - Street 1:705 RILEY HOSPITAL DR
Practice Address - Street 2:RI 1601
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5109
Practice Address - Country:US
Practice Address - Phone:317-274-4842
Practice Address - Fax:317-278-0126
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027222A2080P0008X
IN010272222080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
No2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000736257OtherBCBS MEMORIAL CHILDREN'S HOSPITAL
MI4796133Medicaid
KY64882368Medicaid
IN100059180Medicaid
MI4796133Medicaid
KY64882368Medicaid