Basic Information
| Provider Information | |||||||||
| NPI: | 1255413852 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BULA | ||||||||
| FirstName: | MELANIA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3695 GREEN RD | ||||||||
| Address2: | UNIT 22778 | ||||||||
| City: | BEACHWOOD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441227939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306551869 | ||||||||
| FaxNumber: | 3306553828 | ||||||||
| Practice Location | |||||||||
| Address1: | 5655 HUDSON DR STE 210 | ||||||||
| Address2: | ARIS RADIOLOGY | ||||||||
| City: | HUDSON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442364455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306551869 | ||||||||
| FaxNumber: | 3306553828 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2006 | ||||||||
| LastUpdateDate: | 12/17/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 200500143 | NC | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085P0229X | A111302 | CA | Y | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology | 2085P0229X | 2005-00143 | NC | N | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology |
ID Information
| ID | Type | State | Issuer | Description | 3696645000 | 01 | KY | PASSPORT ADVANTAGE | OTHER | 50022545 | 01 | KY | PASSPORT | OTHER | 7100068810 | 05 | KY | MEDICAID | 00533101 | 01 | KY | MEDICARE | OTHER | 5900259, | 05 | NC | MEDICAID | 200932060 | 05 | IN | MEDICAID |