Provider Demographics
NPI:1457676876
Name:RAPHAEL, JULIA LEIGH (MT-BC)
Entity Type:Individual
Prefix:MS
First Name:JULIA
Middle Name:LEIGH
Last Name:RAPHAEL
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6085 WORLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48301-1541
Mailing Address - Country:US
Mailing Address - Phone:248-227-0582
Mailing Address - Fax:
Practice Address - Street 1:6085 WORLINGTON RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48301-1541
Practice Address - Country:US
Practice Address - Phone:248-227-0582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI09221174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist