Provider Demographics
NPI:1700993177
Name:SUJANSKY, ULRIKE DREES (MD)
Entity Type:Individual
Prefix:DR
First Name:ULRIKE
Middle Name:DREES
Last Name:SUJANSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ULRIKE
Other - Middle Name:DORIS
Other - Last Name:DREES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:200 HIGHLAND TERRACE
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:94062
Mailing Address - Country:US
Mailing Address - Phone:650-851-8279
Mailing Address - Fax:
Practice Address - Street 1:100 S SAN MATEO DR
Practice Address - Street 2:STE 424
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401
Practice Address - Country:US
Practice Address - Phone:650-696-4440
Practice Address - Fax:650-696-4445
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA054876207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G62469Medicare UPIN
00A548760Medicare ID - Type Unspecified