Provider Demographics
NPI:1376967539
Name:GEORGESEN, JULIA
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:
Last Name:GEORGESEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3219 N CLARK ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-1997
Mailing Address - Country:US
Mailing Address - Phone:773-327-4446
Mailing Address - Fax:773-327-9447
Practice Address - Street 1:3219 N CLARK ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-1997
Practice Address - Country:US
Practice Address - Phone:773-327-4446
Practice Address - Fax:773-327-9447
Is Sole Proprietor?:No
Enumeration Date:2014-02-09
Last Update Date:2014-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL090008607174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian