MEDICARE: JULIE MARIOTTI, M.D., P.C.

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	4301070421	MI

General Provider Information

NPI Number	:	1407021603
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JULIE MARIOTTI, M.D., P.C.

Provider Business Mailing Address
First Line	:	2709 W WEBSTER RD
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48073-3700
Country	:	US
Telephone Number	:	248-547-8400
Fax Number	:

Provider Business Practice Location Address
First Line	:	2709 W WEBSTER RD
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48073-3700
Country	:	US
Telephone Number	:	248-547-8400
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JULIE MARIOTTI
Credential	:	M.D.
Telephone Number	:	248-547-8400

Provider Enumeration Date	:	04/28/2008
Last Update Date	:	04/28/2008

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