Healthcare Provider Details

I. General information

NPI: 1528231107
Provider Name (Legal Business Name): KATIE A JULIEN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2008
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 W 7000 S
WEST JORDAN UT
84084-3431
US

IV. Provider business mailing address

5 S 500 W UNIT 711
SALT LAKE CITY UT
84101-4124
US

V. Phone/Fax

Practice location:
  • Phone: 801-569-9133
  • Fax: 801-569-9103
Mailing address:
  • Phone: 801-718-8824
  • Fax: 801-569-9103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number56180871205
License Number StateUT

VIII. Authorized Official

Name: KATIE A JULIEN
Title or Position: OWNER
Credential: MD
Phone: 801-718-8824