Provider Demographics
NPI:1508830894
Name:HIERLWIMMER, ULF R (DO)
Entity Type:Individual
Prefix:
First Name:ULF
Middle Name:R
Last Name:HIERLWIMMER
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 1:126 COLLEGE ST STE D
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49037-3461
Mailing Address - Country:US
Mailing Address - Phone:269-969-8920
Mailing Address - Fax:269-342-0532
Practice Address - Street 1:904 WASHINGTON AVE STE 120
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-7724
Practice Address - Country:US
Practice Address - Phone:616-392-8877
Practice Address - Fax:616-392-1755
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIUH006611207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI111435568Medicaid
MIA74640Medicare UPIN