MEDICARE: DR. JULIANNE BRACKIN DO

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	34-007476	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000250558	OTHER	OH	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851360358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIANNE BRACKIN DO

Provider Business Mailing Address
First Line	:	PO BOX 1834
Second Line	:
City	:	POWELL
State	:	OH
Zip	:	43065-1834
Country	:	US
Telephone Number	:	614-880-9333
Fax Number	:	614-880-9331

Provider Business Practice Location Address
First Line	:	1120 POLARIS PKWY
Second Line	:	SUITE 200
City	:	COLUMBUS
State	:	OH
Zip	:	43240-4042
Country	:	US
Telephone Number	:	614-880-9333
Fax Number	:	614-880-9331

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

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	12/11/2012

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