MEDICARE: MS. JULIA LEIGH RAPHAEL MT-BC

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	174400000X	Specialist	09221	MI

General Provider Information

NPI Number	:	1457676876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JULIA LEIGH RAPHAEL MT-BC

Provider Business Mailing Address
First Line	:	6085 WORLINGTON RD
Second Line	:
City	:	BLOOMFIELD TOWNSHIP
State	:	MI
Zip	:	48301-1541
Country	:	US
Telephone Number	:	248-227-0582
Fax Number	:

Provider Business Practice Location Address
First Line	:	6085 WORLINGTON RD
Second Line	:
City	:	BLOOMFIELD TOWNSHIP
State	:	MI
Zip	:	48301-1541
Country	:	US
Telephone Number	:	248-227-0582
Fax Number	:

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

Provider Enumeration Date	:	03/29/2010
Last Update Date	:	03/29/2010

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