Provider Demographics
NPI:1629161773
Name:ULICH, MICHAEL J (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:ULICH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1232 SHEPPARD ST
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:LA
Mailing Address - Zip Code:71055-3460
Mailing Address - Country:US
Mailing Address - Phone:318-377-7116
Mailing Address - Fax:318-377-9979
Practice Address - Street 1:1232 SHEPPARD ST
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:LA
Practice Address - Zip Code:71055-3460
Practice Address - Country:US
Practice Address - Phone:318-377-7116
Practice Address - Fax:318-377-9979
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA201080208000000X, 2080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1325074Medicaid