Provider Demographics
NPI:1518925379
Name:DUTTON, JULIE (DO)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:DUTTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44555 WOODWARD AVE
Mailing Address - Street 2:STE 308
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-5031
Mailing Address - Country:US
Mailing Address - Phone:248-858-3051
Mailing Address - Fax:248-858-3022
Practice Address - Street 1:44405 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5023
Practice Address - Country:US
Practice Address - Phone:248-858-3051
Practice Address - Fax:248-858-3022
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101014935207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI114788599Medicaid
MII31998Medicare UPIN
MI0M71810043Medicare ID - Type Unspecified
MIP00239107Medicare ID - Type UnspecifiedRAILROAD