Provider Demographics
NPI:1184674772
Name:HALL, JULIA EMILY (MD)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:EMILY
Last Name:HALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6910 4 MILE RD NE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-9625
Mailing Address - Country:US
Mailing Address - Phone:616-682-9632
Mailing Address - Fax:231-733-0534
Practice Address - Street 1:2700 BAKER ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:MUSKEGON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:49444-2157
Practice Address - Country:US
Practice Address - Phone:231-733-6605
Practice Address - Fax:231-733-0534
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301059412207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI332-2053Medicaid
MIG48692Medicare UPIN
MI0M15940Medicare ID - Type Unspecified
MI231858Medicare Oscar/Certification