Provider Demographics
NPI:1083883888
Name:WHITESIDE-DE VOS, JULIA (MD)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:WHITESIDE-DE VOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:
Other - Last Name:WHITESIDE-MICHEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2984 BRIGHTON RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44120-1721
Mailing Address - Country:US
Mailing Address - Phone:216-752-8044
Mailing Address - Fax:
Practice Address - Street 1:2984 BRIGHTON RD
Practice Address - Street 2:
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44120-1721
Practice Address - Country:US
Practice Address - Phone:216-752-8044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-0146207W00000X
CAG61894207W00000X
OH35.080229207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5J482Medicare PIN
ARE62535Medicare UPIN