Provider Demographics
NPI:1932101789
Name:WALLS, ULYSSES C (MD)
Entity Type:Individual
Prefix:DR
First Name:ULYSSES
Middle Name:C
Last Name:WALLS
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:PO BOX 708
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-0708
Mailing Address - Country:US
Mailing Address - Phone:989-255-5400
Mailing Address - Fax:
Practice Address - Street 1:2079 US HIGHWAY 23 S
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-4524
Practice Address - Country:US
Practice Address - Phone:989-340-2550
Practice Address - Fax:989-340-2551
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35675207RC0000X
MI4301086730207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNH48250Medicare UPIN