Provider Demographics
NPI:1174790638
Name:SANDERS, JULIE BABB (MD)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:BABB
Last Name:SANDERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:JULIE
Other - Middle Name:CHRISTY
Other - Last Name:BABB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5841 S MARYLAND AVE
Mailing Address - Street 2:DEPARTMENT OF RADIOLOGY
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1447
Mailing Address - Country:US
Mailing Address - Phone:773-834-9980
Mailing Address - Fax:
Practice Address - Street 1:5841 S MARYLAND AVE
Practice Address - Street 2:DEPARTMENT OF RADIOLOGY
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1447
Practice Address - Country:US
Practice Address - Phone:773-834-9980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2016-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.2031192085R0202X
IL036.1408822085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1116548Medicaid