Healthcare Provider Details

I. General information

NPI: 1457396558
Provider Name (Legal Business Name): FRANSEN AND KULB UROLOGY, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 EASTLAND DR SUITE B
BLOOMINGTON IL
61701-3514
US

IV. Provider business mailing address

1401 EASTLAND DR SUITE B
BLOOMINGTON IL
61701-3514
US

V. Phone/Fax

Practice location:
  • Phone: 309-663-9424
  • Fax: 309-663-6350
Mailing address:
  • Phone: 309-663-9424
  • Fax: 309-663-6350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. THOMAS B KULB
Title or Position: PRESIDENT
Credential: M.D.
Phone: 309-663-9424