Healthcare Provider Details

I. General information

NPI: 1649561887
Provider Name (Legal Business Name): JULIA FANGQIAN ZHU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2011
Last Update Date: 09/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18099 LORAIN ROAD SUITE 404
CLEVELAND OH
44111
US

IV. Provider business mailing address

18099 LORAIN ROAD SUITE 404
CLEVELAND OH
44111
US

V. Phone/Fax

Practice location:
  • Phone: 314-898-8576
  • Fax:
Mailing address:
  • Phone: 314-898-8576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number35,126260
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: