Provider Demographics
NPI:1538194428
Name:REICHHOFF, JULIE ANN (MD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:ANN
Last Name:REICHHOFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:HANEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1502 LONDON RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55812-1788
Mailing Address - Country:US
Mailing Address - Phone:218-727-8228
Mailing Address - Fax:218-740-2798
Practice Address - Street 1:1502 LONDON RD
Practice Address - Street 2:SUITE 102
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55812-1788
Practice Address - Country:US
Practice Address - Phone:218-727-8228
Practice Address - Fax:218-740-2798
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN37133207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN066852400Medicaid
MN066852400Medicaid
MNF89784Medicare UPIN
MN080004683Medicare PIN