Healthcare Provider Details

I. General information

NPI: 1366554677
Provider Name (Legal Business Name): JOHN M ULRICH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9463 HOLLY RD SUITE 100
GRAND BLANC MI
48439-2557
US

IV. Provider business mailing address

3495 S CENTER RD
BURTON MI
48519-1455
US

V. Phone/Fax

Practice location:
  • Phone: 810-695-3766
  • Fax: 810-695-9881
Mailing address:
  • Phone: 810-424-2007
  • Fax: 810-743-1099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number5101010742
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: