# JEFFREY F FULLENKAMP DO LTD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1831178573
- **Authorized official:** JEFFREY F FULLENKAMP DO (PRESIDENT)
- **Authorized official phone:** (309) 762-9711

## Contact information

- **Practice address:** 2701 17TH ST, ROCK ISLAND, IL 61201-5351
- **Practice address phone:** (309) 779-5000
- **Mailing address:** PO BOX 689, LAKE FOREST, IL 60045-0689
- **Mailing address phone:** (847) 615-2200

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | — | IL | Yes |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | IL | — |

## Other

- **Enumeration date:** 01/11/2006
- **Last updated:** 10/29/2007