Provider Demographics
NPI:1114055654
Name:ULLMAN, DAVID STUART (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:STUART
Last Name:ULLMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5727 CANOGA AVE
Mailing Address - Street 2:# 291
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-6518
Mailing Address - Country:US
Mailing Address - Phone:818-992-5981
Mailing Address - Fax:818-992-5967
Practice Address - Street 1:5727 CANOGA AVE
Practice Address - Street 2:# 291
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-6518
Practice Address - Country:US
Practice Address - Phone:818-992-5981
Practice Address - Fax:818-992-5967
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3227213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE3227OtherSTATE LICENSE NUMBER CA.
CAT19284Medicare UPIN
CAE3227Medicare ID - Type Unspecified