| Doctor Name: | LARS ULISSEY |
| NPI Number: | 1821087420 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | A81520 |
| Business Practice Address: | 7321 11th St Bldg 569 Hill Afb, UT - 840565012 |
| Business Phone Number: | 8017774710 |
| Business Fax Number: | |
| Mailing Address: | 5914 Highland Dr, MORGAN |
| State: | UT |
| Postal Code: | 840509758 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 10/17/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | A81520 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |