Provider Demographics
NPI:1093777054
Name:DECKERMAN, JULIE CHENG (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:CHENG
Last Name:DECKERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9094 E MINERAL CIR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-7200
Mailing Address - Country:US
Mailing Address - Phone:303-779-5437
Mailing Address - Fax:303-689-9628
Practice Address - Street 1:9094 E MINERAL CIR
Practice Address - Street 2:SUITE 120
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-7200
Practice Address - Country:US
Practice Address - Phone:303-779-5437
Practice Address - Fax:303-689-9628
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO33375208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
COO1333756Medicaid
COF76472Medicare UPIN