Healthcare Provider Details

I. General information

NPI: 1932101789
Provider Name (Legal Business Name): ULYSSES C WALLS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 09/16/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2079 US HIGHWAY 23 S
ALPENA MI
49707-4524
US

IV. Provider business mailing address

PO BOX 708
ALPENA MI
49707-0708
US

V. Phone/Fax

Practice location:
  • Phone: 989-340-2550
  • Fax: 989-340-2551
Mailing address:
  • Phone: 989-255-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35675
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4301086730
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: