Basic Information
| Provider Information | |||||||||
| NPI: | 1336104397 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | JULIA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 776351 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606776351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025889490 | ||||||||
| FaxNumber: | 5022725116 | ||||||||
| Practice Location | |||||||||
| Address1: | 9880 ANGIES WAY STE 420 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402412850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5023946200 | ||||||||
| FaxNumber: | 5023946210 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2006 | ||||||||
| LastUpdateDate: | 08/27/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 34303 | KY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000350616 | 01 | ANTHEM / NMA | OTHER | 000052154J | 01 | HUMANA / NMA | OTHER | 0662555002 | 01 | CIGNA / NMA | OTHER | 1183758 | 01 | CHA / NMA | OTHER | 2447990000 | 01 | PASSPORT ADVANTAGE | OTHER | 50006769 | 01 | PASSPORT / NMA | OTHER | 64343031 | 05 | KY | MEDICAID | P00212977 | 01 | KY | RAILROAD MEDICARE | OTHER |