Provider Demographics
NPI:1568436566
Name:OKEEFE, JULIE C (MD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:C
Last Name:OKEEFE
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 1:2160 S 1ST AVE
Mailing Address - Street 2:( 1950 S. HARLEM AVE, NO RIVERSIDE, IL. 60546)
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153
Mailing Address - Country:US
Mailing Address - Phone:708-354-9250
Mailing Address - Fax:708-354-8765
Practice Address - Street 1:2160 S 1ST AVE
Practice Address - Street 2:( 1950 S. HARLEM AVE, NO RIVERSIDE, IL. 60546)
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153
Practice Address - Country:US
Practice Address - Phone:708-354-9250
Practice Address - Fax:708-354-8765
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL36100041208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36100041Medicaid
ILK17719Medicare ID - Type Unspecified
G98628Medicare UPIN
IL36100041Medicaid