Basic Information
| Provider Information | |||||||||
| NPI: | 1366753063 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BULLEN | ||||||||
| FirstName: | KEATON | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | |||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3542 | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443093542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3309960347 | ||||||||
| FaxNumber: | 3309960359 | ||||||||
| Practice Location | |||||||||
| Address1: | 75 ARCH ST STE 302 | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443041432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3302535046 | ||||||||
| FaxNumber: | 3302535095 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2010 | ||||||||
| LastUpdateDate: | 07/24/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 34010881 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.