Individual
DR. JULIE D. VAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
430 WARRENVILLE RD STE 310, LISLE, IL 60532-1348
(630) 548-0408
Mailing address
PO BOX 713260, CHICAGO, IL 60677-1260
(630) 469-9200
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036-114087
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036114087
—
IL
01
—
400280
GROUP MEDICARE PTAN
IL
Enumeration date
08/22/2006
Last updated
09/15/2023
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