MEDICARE: JULIE A VANECK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	40831	MN

General Provider Information

NPI Number	:	1013029263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE A VANECK MD

Provider Business Mailing Address
First Line	:	5366 386TH ST NE
Second Line	:
City	:	NORTH BRANCH
State	:	MN
Zip	:	55056-5833
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5366 386TH ST NE
Second Line	:
City	:	NORTH BRANCH
State	:	MN
Zip	:	55056-5833
Country	:	US
Telephone Number	:	651-674-8353
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	04/07/2022

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