Provider Demographics
NPI:1023284536
Name:ULITSKY, OLGA
Entity type:Individual
Prefix:DR
First Name:OLGA
Middle Name:
Last Name:ULITSKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 AVENIDA DEL CIRCO
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-4108
Mailing Address - Country:US
Mailing Address - Phone:941-484-8222
Mailing Address - Fax:
Practice Address - Street 1:1111 AVENIDA DEL CIRCO
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-4108
Practice Address - Country:US
Practice Address - Phone:941-484-8222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.120207207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology