Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service | 630101980 | MI |
NPI | 1447350202 |
---|---|
Provider Name | Dr. Tracy Renea Juliao |
First Address | Farmington Hills, MI 48333-3052 |
Second Address | Farmington Hills, MI 48334-4424 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 17/03/2018 |