Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 29615 | KY |
NPI | 1124085980 |
---|---|
Provider Name | Karl Stephen Ulicny II |
First Address | Cincinnati, OH 45263-6324 |
Second Address | Edgewood, KY 41017 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2006 |
Last Update Date | 04/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0728752 | (05) | OH |
200046180 | (05) | IN |
64932783 | (05) | KY |
F61850 | (02) | KY |