Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081S0010X | Sports Medicine | 096003445 | IL |
N | 213ES0000X | Sports Medicine | 096003445 | IL |
N | 225100000X | Physical Therapist |
NPI | 1346862430 |
---|---|
Provider Name | Zachary J Ullman |
First Address | Clinton Twp, MI 48035-4258 |
Second Address | Palatine, IL 60067-2412 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2020 |
Last Update Date | 30/12/2021 |