Provider Demographics
NPI:1891744694
Name:ROBERT ULSETH LLC
Entity type:Organization
Organization Name:ROBERT ULSETH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:N
Authorized Official - Last Name:ULSETH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-750-5882
Mailing Address - Street 1:1503 BUENOS AIRES BLVD
Mailing Address - Street 2:BUILDING 150
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-6821
Mailing Address - Country:US
Mailing Address - Phone:352-750-5882
Mailing Address - Fax:888-770-3208
Practice Address - Street 1:305 S LINE AVE
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452-4605
Practice Address - Country:US
Practice Address - Phone:352-344-4791
Practice Address - Fax:352-344-3822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty