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General NPI Number Information
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NPI Number | 1831411891
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Entity Type | Individual
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Provider Name | JULIA CAROL ODUGBESAN PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/18/2010
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Last Update Date | 09/18/2025
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Provider Practice Location Address
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Address Line | 6685 E 117TH AVE
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City | CROWN POINT
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State | IN
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Zip | 46307-7808
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Country | US
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Telephone | 872-231-3162
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 74008272
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City | CHICAGO
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State | IL
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Zip | 60674-8272
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Country | US
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Telephone | 800-598-9908
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Fax | 702-977-1496
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10001672A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 085-002821
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License Number State | IL
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