Individual
DR. KRISTINE P PULTORAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
403 E 1ST ST, DIXON, IL 61021
(815) 288-5561
(815) 285-5859
Mailing address
403 E 1ST ST, DIXON, IL 61021-3116
(815) 288-5561
(815) 285-5859
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036.092252
IL
207Q00000X
Family Medicine Physician
036-092252
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036092252
—
IL
01
—
381220005
MEDICARE
IL
01
—
800200006
MEDICARE
IL
Enumeration date
03/08/2006
Last updated
11/17/2022
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