Healthcare Provider Details

I. General information

NPI: 1891778676
Provider Name (Legal Business Name): WILLIAM ULWELLING M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4263 MONTGOMERY BLVD NE SUITE 240
ALBUQUERQUE NM
87109-6747
US

IV. Provider business mailing address

4263 MONTGOMERY BLVD NE SUITE 240
ALBUQUERQUE NM
87109-6747
US

V. Phone/Fax

Practice location:
  • Phone: 505-883-8786
  • Fax: 505-872-2118
Mailing address:
  • Phone: 505-883-8786
  • Fax: 505-872-2118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number84-124
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: