IndividualActive
Kent Bullis, MD
NPI 1710079736 · Adolescent Medicine (Family Medicine) Physician · Ithaca, NY
Provider details
- NPI number
- 1710079736
- Entity type
- Individual
- Primary specialty
- Adolescent Medicine (Family Medicine) PhysicianAllopathic & Osteopathic Physicians
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- License
- 1034097 (IN)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
110 Ho Plz
Ithaca, NY 14853-3102
Phone: (607) 255-5155
Approximate (ZIP-level) locationGet directions
Mailing address
110 Ho Plz
Ithaca, NY 14853-3102
Registry dates
- Enumerated
- 2006-09-28
- Last updated
- 2013-09-26
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.