Provider Demographics
NPI:1962559302
Name:PULLA, BHARATHI (MD)
Entity type:Individual
Prefix:
First Name:BHARATHI
Middle Name:
Last Name:PULLA
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 1:6125 GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-2928
Mailing Address - Country:US
Mailing Address - Phone:262-564-8636
Mailing Address - Fax:262-564-8637
Practice Address - Street 1:6125 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-2928
Practice Address - Country:US
Practice Address - Phone:262-564-8636
Practice Address - Fax:262-564-8637
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI41182207QG0300X, 207QA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34105600Medicaid
WI34105600Medicaid