Provider Demographics
NPI:1205833993
Name:ULANO, HARVEY B (MD)
Entity Type:Individual
Prefix:
First Name:HARVEY
Middle Name:B
Last Name:ULANO
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:PO BOX 417
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34995-0417
Mailing Address - Country:US
Mailing Address - Phone:772-223-5665
Mailing Address - Fax:772-223-5646
Practice Address - Street 1:500 SE OSCEOLA ST
Practice Address - Street 2:SUITE 200
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2364
Practice Address - Country:US
Practice Address - Phone:772-286-1555
Practice Address - Fax:772-287-2140
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20216174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL057277200Medicaid
FLD54841Medicare UPIN
FL057277200Medicaid