Provider Demographics
NPI:1396836680
Name:BRACK, JULIE D (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:D
Last Name:BRACK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8800 PENROSE LN APT 242
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66219-8156
Mailing Address - Country:US
Mailing Address - Phone:913-219-1095
Mailing Address - Fax:
Practice Address - Street 1:23351 PRAIRIE STAR PKWY STE A245
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66227-7301
Practice Address - Country:US
Practice Address - Phone:913-676-8630
Practice Address - Fax:913-676-8635
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS04-26865207Q00000X
MO106289207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G84681Medicare UPIN
KSM114546Medicare ID - Type Unspecified