Basic Information
| Provider Information | |||||||||
| NPI: | 1316226442 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BULAUITAN | ||||||||
| FirstName: | MANUEL | ||||||||
| MiddleName: | EVANGELOS | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10900 WORLD TRADE BLVD | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276174202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192371337 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1964 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WAKE FOREST | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27587 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195540177 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2011 | ||||||||
| LastUpdateDate: | 05/28/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2019-01401 | NC | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 17549 | NH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.