Basic Information
| Provider Information | |||||||||
| NPI: | 1023306735 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUSAN BULEN MD PLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 36179 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857406179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207220777 | ||||||||
| FaxNumber: | 5202909713 | ||||||||
| Practice Location | |||||||||
| Address1: | 1921 W HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857047806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5202969399 | ||||||||
| FaxNumber: | 5202969551 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2011 | ||||||||
| LastUpdateDate: | 10/19/2011 | ||||||||
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| AuthorizedOfficialLastName: | BULEN | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 5202969399 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | MD20625 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.