Basic Information
| Provider Information | |||||||||
| NPI: | 1780888529 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BULSARA | ||||||||
| FirstName: | KETAN | ||||||||
| MiddleName: | RAMANLAL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | UCONN MEDICAL GROUP 263 FARMINGTON AVENUE | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060308063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606798080 | ||||||||
| FaxNumber: | 8606791430 | ||||||||
| Practice Location | |||||||||
| Address1: | 263 FARMINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060300001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606798080 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2007 | ||||||||
| LastUpdateDate: | 09/29/2022 | ||||||||
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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 | 208600000X | 045293 | CT | N | Allopathic & Osteopathic Physicians | Surgery | 207T00000X | 045293 | CT | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.