Provider Demographics
NPI:1275064511
Name:VANDER WEIDE, JULIA (MD)
Entity type:Individual
Prefix:DR
First Name:JULIA
Middle Name:
Last Name:VANDER WEIDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JULIA
Other - Middle Name:
Other - Last Name:ORLOVSKAIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:16836 NEWBURGH RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-1600
Mailing Address - Country:US
Mailing Address - Phone:734-464-4220
Mailing Address - Fax:734-464-5885
Practice Address - Street 1:16836 NEWBURGH RD # 27
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-1600
Practice Address - Country:US
Practice Address - Phone:734-464-4220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43015032152084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry