Provider Demographics
NPI:1679631204
Name:KLESNEY TAIT, JULIA ANN (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:JULIA
Middle Name:ANN
Last Name:KLESNEY TAIT
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:ANN
Other - Last Name:KLESNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-356-3576
Mailing Address - Fax:319-356-3891
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:INTERNAL MEDICINE/PULMON C 33-GH
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-356-4187
Practice Address - Fax:319-356-3891
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA36987207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA29422OtherWELLMARK BCBS
IA0762476Medicaid
IA29422OtherWELLMARK BCBS
I68058Medicare UPIN
IA0762476Medicaid