Provider Demographics
NPI:1063413581
Name:ULRICH, DENNIS ANDRE (MD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:ANDRE
Last Name:ULRICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1655 E HIGHWAY 3094
Mailing Address - Street 2:PO BOX 328
Mailing Address - City:EAST BERNSTADT
Mailing Address - State:KY
Mailing Address - Zip Code:40729-6216
Mailing Address - Country:US
Mailing Address - Phone:606-843-2339
Mailing Address - Fax:606-843-6815
Practice Address - Street 1:1655 E HIGHWAY 3094
Practice Address - Street 2:
Practice Address - City:EAST BERNSTADT
Practice Address - State:KY
Practice Address - Zip Code:40729-6216
Practice Address - Country:US
Practice Address - Phone:606-843-2339
Practice Address - Fax:606-843-6815
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19629207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY080138185OtherRAILROAD MEDCARE
KY000000077248OtherANTHEM, BC/BS
KY64196298Medicaid
KY000000077248OtherANTHEM, BC/BS
KYC64825Medicare UPIN