Individual
JESU JOSEPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2404 CHARLES ST, ROCKFORD, IL 61108-1602
(779) 696-7910
(815) 227-5515
Mailing address
PO BOX 78866, MILWAUKEE, WI 53278-8866
(779) 696-7150
(773) 594-7975
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036-150252
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/15/2017
Last updated
02/25/2021
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