| Angela Bully M.d., P.l.l.c. | |
|
4160 John R St Suite 804 Detroit MI 48201-2020 | |
| (313) 833-1271 | |
| (313) 833-1273 |
| Full Name | Angela Bully M.d., P.l.l.c. |
|---|---|
| Speciality | Internal Medicine |
| Location | 4160 John R St, Detroit, Michigan |
| Authorized Official Name and Position | Angela Bully (PHYSICIAN OWNER) |
| Authorized Official Contact | 3138331271 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Angela Bully M.d., P.l.l.c. 4160 John R St Suite 804 Detroit MI 48201-2020 Ph: (313) 833-1271 | Angela Bully M.d., P.l.l.c. 4160 John R St Suite 804 Detroit MI 48201-2020 Ph: (313) 833-1271 |
| NPI Number | 1922215201 |
|---|---|
| Provider Enumeration Date | 05/17/2007 |
| Last Update Date | 11/02/2009 |
| Medicare PECOS PAC ID | 4789621848 |
|---|---|
| Medicare Enrollment ID | O20050411001176 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922215201 | NPI | - | NPPES |
| 104357008 | Medicaid | MI | |
| 1841257029 | Other | MI | INDIVIDUAL NPI # |
| 4301084811 | Other | MI | PROVIDER LICENSE # |
| P61277 | Other | MI | BLUE CARE NETWORK |
| 1108235671 | Other | MI | BLUE CROSS BLUE SHIELD |
| 1366536088 | Other | MI | INDIVIDUAL NPI # |
| 4301057665 | Other | MI | PROVIDER LICENSE # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 4301057665 (Michigan) | Primary |
| Provider Name | Angela Bully |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1841257029 PECOS PAC ID: 9032156195 Enrollment ID: I20050412000097 |
| Provider Name | Tammie L Bully |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1366536088 PECOS PAC ID: 9335186261 Enrollment ID: I20050412001461 |
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