Provider Demographics
NPI:1316997034
Name:JULIE CHICKS, M.D., S.C.
Entity type:Organization
Organization Name:JULIE CHICKS, M.D., S.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHICKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-375-1580
Mailing Address - Street 1:4922 COLUMBIA RD
Mailing Address - Street 2:
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-9188
Mailing Address - Country:US
Mailing Address - Phone:262-375-1580
Mailing Address - Fax:262-375-9452
Practice Address - Street 1:4922 COLUMBIA RD
Practice Address - Street 2:
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012-9188
Practice Address - Country:US
Practice Address - Phone:262-375-1580
Practice Address - Fax:262-375-9452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI40099207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty