Healthcare Provider Details

I. General information

NPI: 1194747527
Provider Name (Legal Business Name): JULIANA R. KAMINSKI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 FRANKLIN AVE STE 1100
NORMAL IL
61761-0016
US

IV. Provider business mailing address

PO BOX 2451
BLOOMINGTON IL
61702-2451
US

V. Phone/Fax

Practice location:
  • Phone: 309-268-2727
  • Fax: 309-268-3649
Mailing address:
  • Phone: 309-268-2172
  • Fax: 309-268-3649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: