Healthcare Provider Details

I. General information

NPI: 1619959780
Provider Name (Legal Business Name): LARRY A ULREY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14500 HALL RD
STERLING HEIGHTS MI
48313-1229
US

IV. Provider business mailing address

44199 DEQUINDRE RD STE 250
TROY MI
48085-1128
US

V. Phone/Fax

Practice location:
  • Phone: 586-247-4049
  • Fax:
Mailing address:
  • Phone: 248-879-8441
  • Fax: 248-879-6841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4301038065
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: