Provider Demographics
NPI:1366536088
Name:BULLY, TAMMIE LEE (MD)
Entity type:Individual
Prefix:MS
First Name:TAMMIE
Middle Name:LEE
Last Name:BULLY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:29275 NORTHWESTERN HWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1044
Mailing Address - Country:US
Mailing Address - Phone:248-727-1990
Mailing Address - Fax:248-809-3255
Practice Address - Street 1:29275 NORTHWESTERN HWY
Practice Address - Street 2:SUITE 202
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1044
Practice Address - Country:US
Practice Address - Phone:248-727-1990
Practice Address - Fax:248-809-3255
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2014-06-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301084811207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP13720002Medicare ID - Type Unspecified