Basic Information
| Provider Information | |||||||||
| NPI: | 1447600945 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HULUR | ||||||||
| FirstName: | IMGE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 LEROY ST | ||||||||
| Address2: | |||||||||
| City: | POTSDAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 136761786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3152653300 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12327 STRATFORD DR | ||||||||
| Address2: | |||||||||
| City: | CLIVE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503258148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152247088 | ||||||||
| FaxNumber: | 5152249228 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2016 | ||||||||
| LastUpdateDate: | 10/13/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 299032 | NY | Y | Allopathic & Osteopathic Physicians | Dermatology | 207N00000X | MD-47335 | IA | N | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.