Provider Demographics
NPI:1255312955
Name:KLASEN, JULIE ANN (MD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:KLASEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:A
Other - Last Name:SCHANILEC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:525 MAIN ST W
Mailing Address - Street 2:CENTRACARE HEALTH SYSTEM - MELROSE
Mailing Address - City:MELROSE
Mailing Address - State:MN
Mailing Address - Zip Code:56352-1043
Mailing Address - Country:US
Mailing Address - Phone:320-256-4228
Mailing Address - Fax:320-256-7106
Practice Address - Street 1:525 MAIN ST W
Practice Address - Street 2:CENTRACARE HEALTH SYSTEM - MELROSE
Practice Address - City:MELROSE
Practice Address - State:MN
Practice Address - Zip Code:56352-1043
Practice Address - Country:US
Practice Address - Phone:320-256-4228
Practice Address - Fax:320-256-7106
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN46495207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0118174OtherMEDICA HEALTH PLANS
102704OtherONE HEALTH PLAN GREAT WES
9104OtherFIRST HEALTH PLAN
P00172956OtherRR MEDICARE
132132OtherU CARE
312K7SCOtherBLUE CROSS BLUE SHIELD
9104OtherCHAMPUS
1041454OtherPREFERRED ONE
2145443OtherARAZ GROUP AMERICAS PPO
MN1255312955Medicaid
338660100OtherMEDICAL ASSISTANCE
72204OtherMMSI
HP42893OtherHEALTH PARTNERS
P00172956OtherRR MEDICARE
132132OtherU CARE
H55882Medicare UPIN