Provider Demographics
NPI:1104852201
Name:JORDAN, JULIE (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:CHOI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2900 CHANCELLOR DR
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-5427
Mailing Address - Country:US
Mailing Address - Phone:859-341-0288
Mailing Address - Fax:859-363-2140
Practice Address - Street 1:2900 CHANCELLOR DR
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-5427
Practice Address - Country:US
Practice Address - Phone:859-341-0288
Practice Address - Fax:859-363-2140
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38969207R00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
310674100OtherFEDERAL BLACK LUNG
310674100OtherUS DEPT OF LABOR
KY64100241Medicaid
7000160OtherAETNA
000000360586OtherANTHEM
OH610677107043OtherCARESOURCE
KYP00203176Medicare PIN
KY0969428Medicare PIN
KY0399019Medicare PIN
310674100OtherUS DEPT OF LABOR
KY64100241Medicaid
KYP00475046Medicare PIN
KY3313283Medicare PIN