Provider Demographics
NPI:1366403925
Name:RENO, JULIE B (MD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:B
Last Name:RENO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:8700 MIDDLETON CT
Mailing Address - Street 2:
Mailing Address - City:GROSSE ILE
Mailing Address - State:MI
Mailing Address - Zip Code:48138-1299
Mailing Address - Country:US
Mailing Address - Phone:734-676-2667
Mailing Address - Fax:
Practice Address - Street 1:15055 S PLAZA DR
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-5202
Practice Address - Country:US
Practice Address - Phone:734-287-2666
Practice Address - Fax:734-287-3864
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301070956207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4341133Medicaid
MIH34070Medicare UPIN