Provider Demographics
NPI:1790767374
Name:MARIOTTI, JULIE E (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:E
Last Name:MARIOTTI
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 1:2709 W WEBSTER RD
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-3700
Mailing Address - Country:US
Mailing Address - Phone:248-547-8400
Mailing Address - Fax:248-547-8300
Practice Address - Street 1:2709 W WEBSTER RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-3700
Practice Address - Country:US
Practice Address - Phone:248-547-8400
Practice Address - Fax:248-547-8300
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301070421207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ON24300Medicare ID - Type Unspecified
H31593Medicare UPIN