Provider Demographics
NPI:1851360358
Name:BRACKIN, JULIANNE (DO)
Entity Type:Individual
Prefix:DR
First Name:JULIANNE
Middle Name:
Last Name:BRACKIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1834
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-1834
Mailing Address - Country:US
Mailing Address - Phone:614-880-9333
Mailing Address - Fax:614-880-9331
Practice Address - Street 1:1120 POLARIS PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43240-4042
Practice Address - Country:US
Practice Address - Phone:614-880-9333
Practice Address - Fax:614-880-9331
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-007476207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000250558OtherANTHEM
OH2358587Medicaid
OH000000250558OtherANTHEM
OH2358587Medicaid
OH4100391Medicare PIN