Individual
DR. JOHN KEVIN PAULSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7303 N KNOXVILLE AVE, PEORIA, IL 61614-2017
(309) 691-4005
(309) 691-6144
Mailing address
7303 N KNOXVILLE AVE, PEORIA, IL 61614-2017
(309) 691-4005
(309) 691-6144
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036050399
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036050399-2
—
IL
01
—
7215166
BCBS
IL
Enumeration date
06/30/2006
Last updated
02/29/2016
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