Provider Demographics
NPI:1437103421
Name:O'LAUGHLIN, JULIANA Y (MD)
Entity Type:Individual
Prefix:
First Name:JULIANA
Middle Name:Y
Last Name:O'LAUGHLIN
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 1:12440 RIVERVIEW RD
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55347-4605
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1515 SAINT FRANCIS AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-3387
Practice Address - Country:US
Practice Address - Phone:952-445-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN44790208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI344720Medicaid
131404OtherUCARE
MN34447200Medicaid
1040319OtherPREFERRED ONE
12-03552OtherMEDICA CHOICE
730T60LOtherBCBS
MT0151762Medicaid
B710OtherCHAMPUS/TRICARE
12-09026OtherMEDICA PRIMARY
MN34447200Medicaid