Provider Demographics
NPI:1902543747
Name:BULLARD, LUKE
Entity Type:Individual
Prefix:MR
First Name:LUKE
Middle Name:
Last Name:BULLARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1827 E WASHINGTON AVE APT 271
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-5270
Mailing Address - Country:US
Mailing Address - Phone:617-817-5853
Mailing Address - Fax:
Practice Address - Street 1:1827 E WASHINGTON AVE APT 271
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-5270
Practice Address - Country:US
Practice Address - Phone:617-817-5853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-13
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath
No251V00000XAgenciesVoluntary or Charitable