Individual
DR. BROCK B MULLENBACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
6712 N CONVENT ST, BOURBONNAIS, IL 60914-1528
(815) 605-8403
Mailing address
6712 N CONVENT ST, BOURBONNAIS, IL 60914-1528
(815) 605-8403
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
036.164439
IL
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
036.164439
IL
Other
Enumeration date
03/23/2019
Last updated
07/09/2024
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