MEDICARE: MRS. JULIE ANNE HERTZER 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	208000000X	Pediatrics Physician	35072228	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417943606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JULIE ANNE HERTZER MD

Provider Business Mailing Address
First Line	:	3733 PARK EAST DR
Second Line	:	SUITE 102
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-4338
Country	:	US
Telephone Number	:	216-591-1515
Fax Number	:	216-591-1544

Provider Business Practice Location Address
First Line	:	3733 PARK EAST DR
Second Line	:	SUITE 102
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-4338
Country	:	US
Telephone Number	:	216-591-1515
Fax Number	:	216-591-1544

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

Provider Enumeration Date	:	09/22/2005
Last Update Date	:	07/08/2007

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