Provider Demographics
NPI:1578650230
Name:ULRICH, RAFAELA MUNOZ (MD)
Entity Type:Individual
Prefix:MRS
First Name:RAFAELA
Middle Name:MUNOZ
Last Name:ULRICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2844 N MILWAUKEE AVENUE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-7401
Mailing Address - Country:US
Mailing Address - Phone:773-252-1344
Mailing Address - Fax:773-252-5512
Practice Address - Street 1:2844 N MILWAUKEE AVENUE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-7401
Practice Address - Country:US
Practice Address - Phone:773-252-1344
Practice Address - Fax:773-252-5512
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0004604376OtherAETNA
IL0021602210OtherBC BS