Provider Demographics
NPI:1205935210
Name:SICILIA, JULIA (MD)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:SICILIA
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 1:436 TED STEVENS WAY
Mailing Address - Street 2:
Mailing Address - City:KOTZEBUE
Mailing Address - State:AK
Mailing Address - Zip Code:99752-6276
Mailing Address - Country:US
Mailing Address - Phone:907-442-7202
Mailing Address - Fax:907-442-7312
Practice Address - Street 1:436 5TH &TED STEVENS WAY
Practice Address - Street 2:
Practice Address - City:KOTZEBUE
Practice Address - State:AK
Practice Address - Zip Code:99752-4372
Practice Address - Country:US
Practice Address - Phone:907-442-7202
Practice Address - Fax:907-442-7312
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK5532207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKHS191PMedicaid
AKP00291754OtherRAILROAD MEDICARE PIN #
AKHS190PMedicaid
AKMD66291Medicaid
AKP00291754OtherRAILROAD MEDICARE PIN #
AK021310Medicare Oscar/Certification
AKHS190PMedicaid
AKTEZ042Medicare PIN