Simon J Pullukat, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

4301035015 Issued in MI

Practice address

35 South Johnson Suite 2-D
Pontiac, MI 48341

Phone

(268) 338-0860

Fax

(268) 338-6013

NPI assigned

Aug 25, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454457600000",
    "number": "1881702322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1075 N EDGAR RD",
            "city": "MASON",
            "state": "MI",
            "postal_code": "488549584",
            "telephone_number": "248-563-3848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 SOUTH JOHNSON SUITE 2-D",
            "city": "PONTIAC",
            "state": "MI",
            "postal_code": "48341",
            "telephone_number": "268-338-0860",
            "fax_number": "268-338-6013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PULLUKAT",
        "first_name": "SIMON",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-25",
        "last_updated": "2016-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301035015",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "210999610",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sanitha Pulikkotil
• Kimbalah Pulley
• Renease Pulley
• Annamma S Pullukat, MD
• Roy J Pullukat, M.D.
• Trista Jacobia Punt, DO, MS
• Bleona Qafa, MD
• Jiries Azmi Qaqish, MD
• Thomaidha Qipo, MD
• Nicole Rae Quidort, LLMSW

• Family Medicine Physician in Pontiac, MI
• Providers in Pontiac, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.