Individual
JULIE ANN FUNFROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
10050 AUBURN PARK DR, FORT WAYNE, IN 46825-2389
(260) 432-6459
(260) 240-5284
Mailing address
10050 AUBURN PARK DR, FORT WAYNE, IN 46825-2389
(260) 432-6459
(260) 240-5284
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02008137A
IN
207Q00000X
Family Medicine Physician
TL.0009112
CO
390200000X
Student in an Organized Health Care Education/Training Program
TL.0009112
CO
Other
Enumeration date
03/28/2022
Last updated
06/26/2025
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