Provider Demographics
NPI:1770548331
Name:IZZARD, JULIE M (CNM)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:M
Last Name:IZZARD
Suffix:
Gender:F
Credentials:CNM
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Mailing Address - Street 1:26901 BEAUMONT BLVD STE 3D
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:947-522-0307
Mailing Address - Fax:947-522-0307
Practice Address - Street 1:18101 OAKWOOD BLVD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-4089
Practice Address - Country:US
Practice Address - Phone:313-593-7500
Practice Address - Fax:313-593-8840
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2022-07-15
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Provider Licenses
StateLicense IDTaxonomies
MI4704194315367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104304265Medicaid
MI383445481OtherCOMMERCIAL INS
MI420B41027OtherBLUE CROSS BLUE SHIELD