Basic Information
| Provider Information | |||||||||
| NPI: | 1043228349 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAMIKOGLU | ||||||||
| FirstName: | BULENT | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4231 PROGRESS BLVD STE 2 | ||||||||
| Address2: | |||||||||
| City: | PERU | ||||||||
| State: | IL | ||||||||
| PostalCode: | 613541193 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8152240082 | ||||||||
| FaxNumber: | 8152241071 | ||||||||
| Practice Location | |||||||||
| Address1: | 191 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WELLSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 148951150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5857585700 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2006 | ||||||||
| LastUpdateDate: | 01/27/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207KA0200X | E3010 | AR | N | Allopathic & Osteopathic Physicians | Allergy & Immunology | Allergy | 207Y00000X | E3010 | AR | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207Y00000X | 036117864 | IL | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207Y00000X | 303313 | NY | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.