Provider Demographics
NPI:1265482830
Name:CHICKS, JULIE (MD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:CHICKS
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 1:1990 WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WI
Mailing Address - Zip Code:53024-2601
Mailing Address - Country:US
Mailing Address - Phone:262-377-2900
Mailing Address - Fax:262-377-5349
Practice Address - Street 1:1990 WISCONSIN AVE
Practice Address - Street 2:STOP 1
Practice Address - City:GRAFTON
Practice Address - State:WI
Practice Address - Zip Code:53024-2601
Practice Address - Country:US
Practice Address - Phone:262-377-2900
Practice Address - Fax:262-377-5349
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI40099207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIH07286Medicare UPIN