Provider Demographics
NPI:1285694810
Name:DULLUM, MERCEDES K C (MD)
Entity type:Individual
Prefix:
First Name:MERCEDES
Middle Name:K C
Last Name:DULLUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 CLEVELAND CLINIC BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3609
Mailing Address - Country:US
Mailing Address - Phone:954-659-5000
Mailing Address - Fax:954-659-5292
Practice Address - Street 1:2950 CLEVELAND CLINIC BLVD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3609
Practice Address - Country:US
Practice Address - Phone:954-659-5000
Practice Address - Fax:954-659-5292
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0051512208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLB92789Medicare UPIN
FL71636YMedicare ID - Type Unspecified