Provider Demographics
NPI:1336151729
Name:PARK, JULIE U (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:U
Last Name:PARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:5 WELSH COBB CT
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-6074
Mailing Address - Country:US
Mailing Address - Phone:864-752-5687
Mailing Address - Fax:
Practice Address - Street 1:2817 WOODRUFF RD
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-4807
Practice Address - Country:US
Practice Address - Phone:864-610-1947
Practice Address - Fax:864-610-1948
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC302182085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO11736763Medicaid
CO11736763Medicaid
COG97477Medicare UPIN