Provider Demographics
NPI:1275643488
Name:ULRICH, GARY (DO)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:ULRICH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-4214
Mailing Address - Country:US
Mailing Address - Phone:812-242-3005
Mailing Address - Fax:812-242-3054
Practice Address - Street 1:1725 N 5TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47804-4010
Practice Address - Country:US
Practice Address - Phone:812-242-3005
Practice Address - Fax:812-242-3054
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001444A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100253060WMedicaid
IN100253060YMedicaid
255439OtherHEALTHLINK
IN100253060TMedicaid
INP00834674OtherRAILROAD MEDICARE
IN100253060GOtherMOLINA HEALTHCARE MCAID
200024206OtherRAILROAD MCARE PALAMETTO
IN100253060OOtherMOLINA HEALTHCARE MCAID
IN100253060Medicaid
000000089591OtherANTHEM
200024206OtherRAILROAD MCARE PALAMETTO
IN100253060YMedicaid
IN230650CMedicare PIN
000000089591OtherANTHEM
IN192770EMedicare PIN
F29963Medicare UPIN
IN859920NMedicare PIN