Provider Demographics
NPI:1316053127
Name:BULKIN, BRUCE MICHAEL (DPM)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:MICHAEL
Last Name:BULKIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 EL CAMINO REAL
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3228
Mailing Address - Country:US
Mailing Address - Phone:650-342-2420
Mailing Address - Fax:650-342-2391
Practice Address - Street 1:1750 EL CAMINO REAL
Practice Address - Street 2:SUITE 105
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3228
Practice Address - Country:US
Practice Address - Phone:650-342-2420
Practice Address - Fax:650-342-2391
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA000E29390213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E29390Medicare UPIN