Provider Demographics
NPI:1528231107
Name:KATIE A JULIEN MD PC
Entity Type:Organization
Organization Name:KATIE A JULIEN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:JULIEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-718-8824
Mailing Address - Street 1:5 S 500 W UNIT 711
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84101-4124
Mailing Address - Country:US
Mailing Address - Phone:801-718-8824
Mailing Address - Fax:801-569-9103
Practice Address - Street 1:1575 W 7000 S
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-3431
Practice Address - Country:US
Practice Address - Phone:801-569-9133
Practice Address - Fax:801-569-9103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-03
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT56180871205261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1386691251OtherNPI NUMBER
UT529737725001Medicaid
UTUT03487OtherSUBMITTER ID
UT529737725001Medicaid
UTI09844Medicare UPIN