Individual
JULIE G VANDERBILT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2320 HIGH ST, BLUE ISLAND, IL 60406-2426
(708) 388-5500
(708) 388-5672
Mailing address
1860 PAYSPHERE CIR, CHICAGO, IL 60674-2426
(630) 469-2000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036090162
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036090162
—
IL
01
—
080112274
RAILROAD MEDICARE
IL
Enumeration date
04/13/2006
Last updated
10/31/2019
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