Provider Demographics
NPI:1467416990
Name:LEBLANC, JULIA KIM (MD)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:KIM
Last Name:LEBLANC
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 1:875 S ROUTE 31
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-8190
Mailing Address - Country:US
Mailing Address - Phone:779-220-5500
Mailing Address - Fax:779-220-5571
Practice Address - Street 1:875 SOUTH ROUTE 31
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-8190
Practice Address - Country:US
Practice Address - Phone:779-220-5500
Practice Address - Fax:779-220-5571
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01055473207RG0100X
IL036093017207RG0100X
IN01055473A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200356110Medicare ID - Type Unspecified
IN264910FUMedicare ID - Type Unspecified
ING45946Medicare UPIN