1417004862 NPI number — MS. JULIE G MIDDLIN AT/ATC, CSCS, CES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417004862 NPI number — MS. JULIE G MIDDLIN AT/ATC, CSCS, CES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MIDDLIN
Provider First Name:
JULIE
Provider Middle Name:
G
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
AT/ATC, CSCS, CES
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MIDDLIN
Provider Other First Name:
JULIE
Provider Other Middle Name:
G
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA, NCC, LLPC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1417004862
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2040 LEITCH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FERNDALE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48220-1510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-266-5616
Provider Business Mailing Address Fax Number:
248-605-3525

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
39425 GARFIELD RD STE 23
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLINTON TWP
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-266-5616
Provider Business Practice Location Address Fax Number:
248-605-3525
Provider Enumeration Date:
01/05/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  L148244 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2255A2300X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101Y00000X , with the licence number: 6401014131 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)