Basic Information
| Provider Information | |||||||||
| NPI: | 1487944773 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BULTHUIS | ||||||||
| FirstName: | LUKE | ||||||||
| MiddleName: | WILLIAM | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6670 ALTON PKWY | ||||||||
| Address2: | MOB 1 | ||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926183734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8889882800 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6670 ALTON PKWY | ||||||||
| Address2: | MOB 1 | ||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926183734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8889882800 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2011 | ||||||||
| LastUpdateDate: | 06/21/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207X00000X | MD2017-0568 | NM | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.