Individual
DR. JULIE ANN DEROSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
10090 GEORGIA STREET, SUITE #3, CROWN POINT, IN 46307
(219) 472-4077
(219) 267-1720
Mailing address
10090 GEORGIA STREET, SUITE 3, CROWN POINT, IN 46307
(219) 472-4077
(219) 267-1720
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01049022A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01049022A
INDIANA LICENSE
IN
01
—
01049022B
CSR
IN
05
—
200540460
—
IN
Enumeration date
01/31/2006
Last updated
03/07/2023
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