Healthcare Provider Details

I. General information

NPI: 1437472719
Provider Name (Legal Business Name): CHRISTOPHER R ULRICH PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2010
Last Update Date: 03/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 E MAIN ST
HART MI
49420-1190
US

IV. Provider business mailing address

611 E MAIN ST
HART MI
49420-1190
US

V. Phone/Fax

Practice location:
  • Phone: 231-873-5675
  • Fax: 231-873-1825
Mailing address:
  • Phone: 231-873-5675
  • Fax: 231-873-1825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601005544
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: