Provider Demographics
NPI:1215191960
Name:JULIE G. GANDEE DO PLLC
Entity Type:Organization
Organization Name:JULIE G. GANDEE DO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:G
Authorized Official - Last Name:GANDEE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:859-624-0404
Mailing Address - Street 1:1054 CENTER DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-3851
Mailing Address - Country:US
Mailing Address - Phone:859-624-0404
Mailing Address - Fax:859-624-0409
Practice Address - Street 1:1054 CENTER DR
Practice Address - Street 2:SUITE 5
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-3851
Practice Address - Country:US
Practice Address - Phone:859-624-0404
Practice Address - Fax:859-624-0409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-11
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY03099207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100060680Medicaid
KY00710Medicare PIN