Healthcare Provider Details

I. General information

NPI: 1023019460
Provider Name (Legal Business Name): DAVID MICHAEL ULICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 01/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W CALIFORNIA BLVD DEPARTMENT OF EMERGENCY MEDICINE
PASADENA CA
91109
US

IV. Provider business mailing address

100 W CALIFORNIA BLVD PO BOX 7013 HUNTINGTON HOSPITAL
PASADENA CA
91109-7013
US

V. Phone/Fax

Practice location:
  • Phone: 626-397-5106
  • Fax:
Mailing address:
  • Phone: 626-397-5106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD026268
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA100612
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: