Provider Demographics
NPI:1366554677
Name:ULRICH, JOHN M (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:ULRICH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3495 S CENTER RD
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48519-1455
Mailing Address - Country:US
Mailing Address - Phone:810-424-2007
Mailing Address - Fax:810-743-1099
Practice Address - Street 1:9463 HOLLY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-2557
Practice Address - Country:US
Practice Address - Phone:810-695-3766
Practice Address - Fax:810-695-9881
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101010742207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3246111Medicaid
MI3246111Medicaid
MIP01160001Medicare PIN