Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 0102203934 | VA |
Y | 208600000X | Surgeon | 0102203934 | VA |
N | 208200000X | Surgeon | 5101016161 | MI |
N | 208600000X | Surgeon | 5101016161 | MI |
NPI | 1013149707 |
---|---|
Provider Name | Dr. Vinson Consolacion Ulep |
First Address | Manistee, MI 49660-8904 |
Second Address | Martinsville, VA 24112-1929 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2009 |
Last Update Date | 25/09/2018 |