| Brandon C Bultsma, Dpm, Pc | |
|
1565 Sam Rittenberg Blvd Ste 104 Charleston SC 29407-4128 | |
| (854) 444-3129 | |
| Not Available |
| Full Name | Brandon C Bultsma, Dpm, Pc |
|---|---|
| Speciality | Podiatrist |
| Location | 1565 Sam Rittenberg Blvd Ste 104, Charleston, South Carolina |
| Authorized Official Name and Position | Brandon Bultsma (PRESIDENT) |
| Authorized Official Contact | 8544443129 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brandon C Bultsma, Dpm, Pc 1565 Sam Rittenberg Blvd Ste 100 Charleston SC 29407-4128 Ph: (843) 642-0074 | Brandon C Bultsma, Dpm, Pc 1565 Sam Rittenberg Blvd Ste 104 Charleston SC 29407-4128 Ph: (854) 444-3129 |
| NPI Number | 1396232880 |
|---|---|
| Provider Enumeration Date | 04/19/2018 |
| Last Update Date | 05/09/2024 |
| Medicare PECOS PAC ID | 0840548475 |
|---|---|
| Medicare Enrollment ID | O20200921002382 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396232880 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 213ES0103X | Podiatrist - Foot & Ankle Surgery | (* (Not Available)) | Primary |
| Provider Name | Brandon Bultsma |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1033522784 PECOS PAC ID: 8123397734 Enrollment ID: I20200921002466 |
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