Provider Demographics
NPI:1629245030
Name:JULIE L. REIHSEN M.D./PA
Entity Type:Organization
Organization Name:JULIE L. REIHSEN M.D./PA
Other - Org Name:DALLAS FAMILY MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:REIHSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-248-2020
Mailing Address - Street 1:16901 DALLAS PKWY
Mailing Address - Street 2:STE 208
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-5226
Mailing Address - Country:US
Mailing Address - Phone:972-248-2020
Mailing Address - Fax:972-248-2028
Practice Address - Street 1:16901 DALLAS PKWY
Practice Address - Street 2:STE 208
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-5226
Practice Address - Country:US
Practice Address - Phone:972-248-2020
Practice Address - Fax:972-248-2028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5457208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0007QFOtherBLUE CROSS BLUE SHIELD
TXE-788-76Medicare UPIN