Provider Demographics
NPI:1467488734
Name:PLATT, JULIE S (MD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:S
Last Name:PLATT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:S
Other - Last Name:WATKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1234 E. DUPONT RD.
Mailing Address - Street 2:3
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-1545
Mailing Address - Country:US
Mailing Address - Phone:260-373-9728
Mailing Address - Fax:260-458-5664
Practice Address - Street 1:11123 PARKVIEW PLAZA DR.
Practice Address - Street 2:SUITE 202
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845
Practice Address - Country:US
Practice Address - Phone:260-672-6520
Practice Address - Fax:260-490-6261
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045652A207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200444750Medicaid
IN000000692854OtherANTHEM
IN200444750Medicaid
IN000000692854OtherANTHEM