Provider Demographics
NPI:1841726932
Name:BHULLER, SIDRA B (DO)
Entity type:Individual
Prefix:DR
First Name:SIDRA
Middle Name:B
Last Name:BHULLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 E MICHIGAN AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-1806
Mailing Address - Country:US
Mailing Address - Phone:517-364-5200
Mailing Address - Fax:
Practice Address - Street 1:1140 E MICHIGAN AVE STE 300
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1806
Practice Address - Country:US
Practice Address - Phone:517-364-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-10
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101026829208600000X
COTL.000651208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery