Provider Demographics
NPI:1942221437
Name:MOKHTAR, JULIE M (DO)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:M
Last Name:MOKHTAR
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 1:650 MCMILLEN ST
Mailing Address - Street 2:
Mailing Address - City:FORT ATKINSON
Mailing Address - State:WI
Mailing Address - Zip Code:53538-1275
Mailing Address - Country:US
Mailing Address - Phone:920-563-8900
Mailing Address - Fax:920-563-0318
Practice Address - Street 1:650 MCMILLEN ST
Practice Address - Street 2:
Practice Address - City:FORT ATKINSON
Practice Address - State:WI
Practice Address - Zip Code:53538-1275
Practice Address - Country:US
Practice Address - Phone:920-563-8900
Practice Address - Fax:920-563-0318
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI36399-021207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30065800Medicaid
WI30065800Medicaid
WIBM4454067OtherDEA
WI30065800Medicaid