Provider Demographics
NPI:1588708770
Name:KLEMENS, JULIE C (MD)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:C
Last Name:KLEMENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 S MAIN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-2670
Mailing Address - Country:US
Mailing Address - Phone:630-652-0606
Mailing Address - Fax:630-652-9900
Practice Address - Street 1:130 S MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-2670
Practice Address - Country:US
Practice Address - Phone:630-652-0606
Practice Address - Fax:630-652-9900
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207K00000X, 207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Not Answered207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILI48534Medicare UPIN
ILK24584Medicare ID - Type Unspecified