Healthcare Provider Details

I. General information

NPI: 1467488734
Provider Name (Legal Business Name): JULIE S PLATT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIE S WATKINS

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 03/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11123 PARKVIEW PLAZA DR. SUITE 202
FORT WAYNE IN
46845
US

IV. Provider business mailing address

1234 E. DUPONT RD. 3
FORT WAYNE IN
46825-1545
US

V. Phone/Fax

Practice location:
  • Phone: 260-672-6520
  • Fax: 260-490-6261
Mailing address:
  • Phone: 260-373-9728
  • Fax: 260-458-5664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number01045652A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: