Healthcare Provider Details

I. General information

NPI: 1669167656
Provider Name (Legal Business Name): JULIUS MEMBRERE OREJUDOS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 CIVIC CENTER BLVD
PHILADELPHIA PA
19104-5127
US

IV. Provider business mailing address

100 W ROOSEVELT AVE UNIT 205
BENSENVILLE IL
60106-4108
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-7300
  • Fax: 215-615-5920
Mailing address:
  • Phone: 510-862-5228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number135.001195
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSC007622
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number135.001195
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: