Provider Demographics
NPI:1013149707
Name:ULEP, VINSON CONSOLACION (DO)
Entity Type:Individual
Prefix:DR
First Name:VINSON
Middle Name:CONSOLACION
Last Name:ULEP
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Gender:M
Credentials:DO
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Mailing Address - Street 1:1293 E PARKDALE AVE
Mailing Address - Street 2:STE 2300
Mailing Address - City:MANISTEE
Mailing Address - State:MI
Mailing Address - Zip Code:49660-8904
Mailing Address - Country:US
Mailing Address - Phone:276-666-7723
Mailing Address - Fax:276-670-7046
Practice Address - Street 1:319 HOSPITAL DR
Practice Address - Street 2:STE 210
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-1929
Practice Address - Country:US
Practice Address - Phone:276-666-7723
Practice Address - Fax:276-670-7046
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-14
Last Update Date:2018-09-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101016161208600000X
VA0102203934208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIE16002105Medicare PIN