Healthcare Provider Details

I. General information

NPI: 1700148673
Provider Name (Legal Business Name): CHAD JASON ULFERTS H.I.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2012
Last Update Date: 06/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 1ST ST S
WILLMAR MN
56201-4236
US

IV. Provider business mailing address

2800 W HIGGINS RD STE. 120
HOFFMAN ESTATES IL
60169-2071
US

V. Phone/Fax

Practice location:
  • Phone: 320-214-7737
  • Fax: 320-235-0797
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2723
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: