Provider Demographics
NPI:1972538742
Name:STRIDE, JULIE M (DPM)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:M
Last Name:STRIDE
Suffix:
Gender:M
Credentials:DPM
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 64
Mailing Address - Street 2:
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044-0064
Mailing Address - Country:US
Mailing Address - Phone:847-234-6164
Mailing Address - Fax:847-535-7840
Practice Address - Street 1:1200 N WESTMORELAND RD
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1601
Practice Address - Country:US
Practice Address - Phone:847-234-6164
Practice Address - Fax:847-535-7840
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0004905313OtherBLUE CROSS BLUE SHIELD
5020028OtherAETNA
IL337450Medicare ID - Type UnspecifiedMEDICARE
ILU36959Medicare UPIN