Provider Demographics
NPI:1710032891
Name:OREILLY, JULIE C (MD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:C
Last Name:OREILLY
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 1:2457 N MAYFAIR RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-1405
Mailing Address - Country:US
Mailing Address - Phone:414-476-0306
Mailing Address - Fax:414-476-7720
Practice Address - Street 1:2457 N MAYFAIR RD
Practice Address - Street 2:SUITE 103
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-1405
Practice Address - Country:US
Practice Address - Phone:414-476-0306
Practice Address - Fax:414-476-7720
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI26270207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E10295Medicare UPIN
73823Medicare ID - Type Unspecified