Provider Demographics
NPI:1922031475
Name:BIRLENBACH, ULRICH (MD)
Entity Type:Individual
Prefix:
First Name:ULRICH
Middle Name:
Last Name:BIRLENBACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5920 100TH ST SW
Mailing Address - Street 2:SUITE 32
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-2751
Mailing Address - Country:US
Mailing Address - Phone:253-582-7220
Mailing Address - Fax:253-582-0586
Practice Address - Street 1:5920 100TH ST SW
Practice Address - Street 2:SUITE 32
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2751
Practice Address - Country:US
Practice Address - Phone:253-582-7220
Practice Address - Fax:253-582-0586
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00022870174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG001000097Medicare PIN
WAA08325Medicare UPIN