Healthcare Provider Details

I. General information

NPI: 1235468851
Provider Name (Legal Business Name): JULIE ANN WEBB PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2009
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6777 W. MAPLE ROAD
W. BLOOMFIELD MI
48322
US

IV. Provider business mailing address

6777 W. MAPLE ROAD
WEST BLOOMFIELD MI
48322
US

V. Phone/Fax

Practice location:
  • Phone: 248-325-1000
  • Fax: 248-852-0305
Mailing address:
  • Phone: 248-852-9290
  • Fax: 248-852-0305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601005640
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: