Provider Demographics
NPI:1578592275
Name:MONTEJO, JULIA LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:JULIA
Middle Name:LYNN
Last Name:MONTEJO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11104 PARKVIEW CIRCLE DR STE 10
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1733
Practice Address - Country:US
Practice Address - Phone:260-425-6070
Practice Address - Fax:260-425-6073
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN46049207K00000X
IN01097106A207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN171819OtherUCARE MN #
MN7892445OtherAETNA INS
MNHP39054OtherHEALTHPARTNERS
MN1034667OtherPREFERRED ONE
MN163437200Medicaid
MN081K7MOOtherBCBS OF MN
MN1847598OtherAMERICA'S PPO
MN0200175OtherMEDICA #
MN6606594OtherMEDICA UC #
MNH86235Medicare UPIN