Individual
JULIE C BLOSSOM-HARTLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
300 LAFAYETTE AVE SE STE 4000, GRAND RAPIDS, MI 49503-4692
(616) 685-6922
Mailing address
111 BREWSTER ST, FCC A, PAWTUCKET, RI 02860
(401) 729-2304
(401) 729-2541
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301509984
MI
207Q00000X
Family Medicine Physician
LP04116
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4301509984
STATE OF MICHIGAN MEDICAL LICENSE
MI
01
—
LP04116
RHODE ISLAND MEDICAL LICENSE
RI
Enumeration date
06/21/2017
Last updated
10/26/2023
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