Provider Demographics
NPI:1386806354
Name:GATLIN, JULIANNE (DO)
Entity type:Individual
Prefix:
First Name:JULIANNE
Middle Name:
Last Name:GATLIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 REMINGTON BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-5817
Mailing Address - Country:US
Mailing Address - Phone:630-759-4800
Mailing Address - Fax:
Practice Address - Street 1:329 REMINGTON BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-5817
Practice Address - Country:US
Practice Address - Phone:630-759-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036127416207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
367830Medicare PIN