Provider Demographics
NPI:1427014315
Name:KELCH, JULIE (MD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:KELCH
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 1:616 UNIVERSAL DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-4787
Mailing Address - Country:US
Mailing Address - Phone:850-385-1839
Mailing Address - Fax:850-386-8371
Practice Address - Street 1:616 UNIVERSAL DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-4787
Practice Address - Country:US
Practice Address - Phone:850-385-1839
Practice Address - Fax:850-386-8371
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME48826207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL045997600Medicaid
FL04648OtherBLUE CROSS/BLUE SHIELD
FL05235OtherUNIVERSAL HEALTH CARE
FLD51072Medicare UPIN
FL045997600Medicaid