Provider Demographics
NPI:1073507059
Name:MASTERS, JULIE G (DO)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:G
Last Name:MASTERS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3950 S ROCHESTER RD
Mailing Address - Street 2:SUITE 1300
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-5160
Mailing Address - Country:US
Mailing Address - Phone:248-659-1150
Mailing Address - Fax:248-659-1151
Practice Address - Street 1:3950 S ROCHESTER RD
Practice Address - Street 2:SUITE 1300
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5160
Practice Address - Country:US
Practice Address - Phone:248-659-1150
Practice Address - Fax:248-659-1151
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJM014833207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4625996Medicaid
MI0M0217080Medicare PIN
MI4625996Medicaid