Provider Demographics
NPI:1699735183
Name:PRAUS, JULIE MARIE (MD)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:MARIE
Last Name:PRAUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DOUGLAS
Other - Middle Name:JAMES
Other - Last Name:PRAUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1919 UNIVERSIT AVE W.
Mailing Address - Street 2:STE 200
Mailing Address - City:ST. PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-3453
Mailing Address - Country:US
Mailing Address - Phone:651-266-7999
Mailing Address - Fax:651-266-7850
Practice Address - Street 1:1919 UNIVERSITY AVE W.
Practice Address - Street 2:STE 200
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-3453
Practice Address - Country:US
Practice Address - Phone:651-266-7999
Practice Address - Fax:651-266-7850
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA042805E103T00000X
IA28946103T00000X
NE18062103T00000X
MN42241103T00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
E59941Medicare UPIN
260002168Medicare ID - Type Unspecified