Provider Demographics
NPI:1053831008
Name:MULAT, BARUH BRUCK (MD)
Entity type:Individual
Prefix:
First Name:BARUH
Middle Name:BRUCK
Last Name:MULAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:980-487-1400
Mailing Address - Fax:980-487-1400
Practice Address - Street 1:808 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3858
Practice Address - Country:US
Practice Address - Phone:980-487-1400
Practice Address - Fax:980-487-1400
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2024-01374207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine