Provider Demographics
NPI:1336269968
Name:PENN, JULIA HINKLE (MD)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:HINKLE
Last Name:PENN
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 1:1045 W GLEN OAKS LN
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-3467
Mailing Address - Country:US
Mailing Address - Phone:262-241-4664
Mailing Address - Fax:262-241-1012
Practice Address - Street 1:1045 W GLEN OAKS LN
Practice Address - Street 2:SUITE 1
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3467
Practice Address - Country:US
Practice Address - Phone:262-241-4664
Practice Address - Fax:262-241-1012
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI236772084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIP00798910OtherRAILROAD MEDICARE
WIP00798910OtherRAILROAD MEDICARE
WIB55675Medicare UPIN