Provider Demographics
NPI:1437150281
Name:ULRICH, WILLIAM J III (PAC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:J
Last Name:ULRICH
Suffix:III
Gender:M
Credentials:PAC
Other - Prefix:
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Mailing Address - Street 1:2700 BAKER ST FL 3
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-2157
Mailing Address - Country:US
Mailing Address - Phone:231-733-6607
Mailing Address - Fax:231-737-0534
Practice Address - Street 1:2700 BAKER ST FL 3
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-2157
Practice Address - Country:US
Practice Address - Phone:231-733-6607
Practice Address - Fax:231-737-0534
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601001128363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI231009Medicare Oscar/Certification
MIS41421Medicare UPIN