Provider Demographics
NPI:1669459129
Name:BANCROFT, JULIA A (DO)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:A
Last Name:BANCROFT
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:PO BOX 155
Mailing Address - Street 2:CHRISTOPHER GREATER AREA RURAL HEALTH PLANNING CORP
Mailing Address - City:CHRISTOPHER
Mailing Address - State:IL
Mailing Address - Zip Code:62822
Mailing Address - Country:US
Mailing Address - Phone:618-724-2401
Mailing Address - Fax:618-724-2571
Practice Address - Street 1:6294 STATE HWY 154
Practice Address - Street 2:
Practice Address - City:SESSER
Practice Address - State:IL
Practice Address - Zip Code:62884
Practice Address - Country:US
Practice Address - Phone:618-625-6979
Practice Address - Fax:618-625-5362
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036098406207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036098406Medicaid
049587OtherHEALTH ALLIANCE
413721OtherHEALTHLINK
049587OtherHEALTH ALLIANCE
L71768Medicare ID - Type Unspecified