=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427663632
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JULIA-HEYA KARCIC DPM LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2020
-----------------------------------------------------
Last Update Date | 09/14/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1611 PEACH ST STE 290
-----------------------------------------------------
City | ERIE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16501-2126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-882-2663
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 223 W 7TH ST
-----------------------------------------------------
City | ERIE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16501-1601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-448-2717
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHYSICIAN
-----------------------------------------------------
Name | DR. JULIA-HEYA KARCIC
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 814-882-2663
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP1100X
-----------------------------------------------------
Taxonomy Name | Podiatric Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------