Organization
JEFFREY F FULLENKAMP DO LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY F FULLENKAMP DO (PRESIDENT)
(309) 762-9711
Entity
Organization
Contact information
Practice address
2701 17TH ST, ROCK ISLAND, IL 61201-5351
(309) 779-5000
Mailing address
PO BOX 689, LAKE FOREST, IL 60045-0689
(847) 615-2200
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
IL
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2994418
—
IA
05
—
3994418
—
IA
Enumeration date
01/11/2006
Last updated
10/29/2007
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