Provider Demographics
NPI:1700912219
Name:MCCANN, ULYSSE GEORGE II (MD)
Entity type:Individual
Prefix:DR
First Name:ULYSSE
Middle Name:GEORGE
Last Name:MCCANN
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LEE
Other - Middle Name:
Other - Last Name:MCCANN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:801-357-7081
Mailing Address - Fax:801-357-7351
Practice Address - Street 1:1134 N 500 W
Practice Address - Street 2:#100
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3383
Practice Address - Country:US
Practice Address - Phone:801-357-7081
Practice Address - Fax:801-357-7351
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-01389208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5901721Medicaid
I40552Medicare UPIN
UT000064146Medicare PIN
NC5901721Medicaid