Individual
JULIE A UTENDORF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2003 STULTS RD, SUITE 100, HUNTINGTON, IN 46750-1291
(260) 356-5424
(260) 358-2090
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01048972A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000655780
ANTHEM
IN
05
—
200147140A
—
IN
05
—
200956680
—
IN
Enumeration date
07/18/2005
Last updated
01/04/2023
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