Provider Demographics
NPI:1306816178
Name:SERVOSS, JULIE C (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:C
Last Name:SERVOSS
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 NW 12TH AVE
Mailing Address - Street 2:JMT-EAST 1007
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1051
Mailing Address - Country:US
Mailing Address - Phone:305-243-4664
Mailing Address - Fax:
Practice Address - Street 1:3848 FAU BLVD STE 305
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6437
Practice Address - Country:US
Practice Address - Phone:561-455-3627
Practice Address - Fax:561-393-7312
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94610174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH98686Medicare UPIN
FL41082ZMedicare ID - Type Unspecified