Provider Demographics
NPI:1811231426
Name:CRUZ, JULIE LYNN (MD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:LYNN
Last Name:CRUZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:LYNN
Other - Last Name:HOUSEWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3450 N MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46208-4437
Mailing Address - Country:US
Mailing Address - Phone:317-916-5009
Mailing Address - Fax:317-916-5005
Practice Address - Street 1:3450 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208-4437
Practice Address - Country:US
Practice Address - Phone:317-916-5009
Practice Address - Fax:317-916-5005
Is Sole Proprietor?:No
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060710A207ZB0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine