Provider Demographics
NPI:1538329628
Name:HAVLOVIC, JULIA (MD)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:HAVLOVIC
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 1:8592 POTTER PARK DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-5467
Mailing Address - Country:US
Mailing Address - Phone:941-921-6618
Mailing Address - Fax:941-922-0556
Practice Address - Street 1:8592 POTTER PARK DR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238-5467
Practice Address - Country:US
Practice Address - Phone:419-216-6189
Practice Address - Fax:941-922-0556
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4814207Q00000X
FLME146488207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07957719Medicaid
LA2159992Medicaid
AK4814OtherOCCUPATIONAL LICENSE
MS07957719Medicaid