Provider Demographics
NPI:1205851318
Name:REEVES, JULIE A (MD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:REEVES
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 1:3637 MEDINA RD
Mailing Address - Street 2:SUITE 70
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-9654
Mailing Address - Country:US
Mailing Address - Phone:330-764-7378
Mailing Address - Fax:330-723-8357
Practice Address - Street 1:3637 MEDINA RD
Practice Address - Street 2:SUITE 70
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-9654
Practice Address - Country:US
Practice Address - Phone:330-764-7378
Practice Address - Fax:330-723-8357
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35076576R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2169835Medicaid
OH0892962Medicare PIN
OHG73374Medicare UPIN