Individual
FREDRIC C. KULLBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
535 ROXBURY RD, SUITE B600, ROCKFORD, IL 61107-5076
(815) 397-7212
(815) 397-2539
Mailing address
535 ROXBURY RD, SUITE B600, ROCKFORD, IL 61107-5076
(815) 397-7212
(815) 397-2539
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
036 062004
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036 062004
—
IL
01
—
101 00574
BLUE CROSS BLUE SHIELD
IL
01
—
290000247
RAILROAD MEDICARE
IL
Enumeration date
08/17/2006
Last updated
05/04/2016
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