Provider Demographics
NPI:1538488788
Name:BROWN, JULIE IRENE (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:IRENE
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:JULIE
Other - Middle Name:IRENE
Other - Last Name:RIEWERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 N COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:GENESEO
Mailing Address - State:IL
Mailing Address - Zip Code:61254-1095
Mailing Address - Country:US
Mailing Address - Phone:309-944-1275
Mailing Address - Fax:309-944-9200
Practice Address - Street 1:600 N COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:GENESEO
Practice Address - State:IL
Practice Address - Zip Code:61254-1095
Practice Address - Country:US
Practice Address - Phone:309-944-1275
Practice Address - Fax:309-944-9200
Is Sole Proprietor?:No
Enumeration Date:2010-05-27
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN15064207Q00000X
FLME111895207Q00000X
IL036.133697207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1538488788Medicaid
IL1538488788Medicaid