Active NPI
Julie Hairston, D.O.
- Family Medicine Physician
- Southfield, MI
National Provider Identifier
1366402133
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Practice address
- 17422 W 10 Mile Rd
B
Southfield, MI 48075-2925 - Phone
- (248) 443-7245
- Fax
- (248) 443-7258
- NPI assigned
- Mar 24, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MI | Primary |
Addresses
Primary practice location
17422 W 10 Mile Rd
B
Southfield, MI 48075-2925
Mailing address
PO Box 36606
Grosse Pointe, MI 48236-0606
Phone (248) 443-7245
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4265873 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 510102693 | MI | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143158400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1189296000000",
"number": "1366402133",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 36606",
"city": "GROSSE POINTE",
"state": "MI",
"postal_code": "482360606",
"telephone_number": "248-443-7245",
"fax_number": "248-443-7258"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17422 W 10 MILE RD",
"address_2": "B",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480752925",
"telephone_number": "248-443-7245",
"fax_number": "248-443-7258"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAIRSTON",
"first_name": "JULIE",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-24",
"last_updated": "2007-09-09",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MI",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4265873",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Southfield, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.