Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 5101010742 | MI |
NPI | 1366554677 |
---|---|
Provider Name | Dr. John M Ulrich |
First Address | Burton, MI 48519-1455 |
Second Address | Grand Blanc, MI 48439-2557 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 20/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3246111 | (05) | MI |
F97522 | (02) | MI |