Provider Demographics
NPI:1730167396
Name:ULLERY, MICHAEL CHRIS (MD)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:CHRIS
Last Name:ULLERY
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 1:500 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-6524
Mailing Address - Country:US
Mailing Address - Phone:916-920-1200
Mailing Address - Fax:916-830-2001
Practice Address - Street 1:500 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6524
Practice Address - Country:US
Practice Address - Phone:916-920-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG65413207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG65413OtherMEDICAL LICENSE #
CA110218176OtherRAILROAD MEDICARE
CA110218176OtherRAILROAD MEDICARE
CAG65413OtherMEDICAL LICENSE #