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General NPI Number Information
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NPI Number | 1144970575
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Entity Type | Individual
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Provider Name | JULIE ANN FUNFROCK DO
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Gender | Female
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Dates
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Enumeration Date | 03/28/2022
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Last Update Date | 06/26/2025
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Provider Practice Location Address
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Address Line | 10050 AUBURN PARK DR
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City | FORT WAYNE
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State | IN
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Zip | 46825-2389
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Country | US
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Telephone | 260-432-6459
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Fax | 260-240-5284
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Provider Business Mailing Address
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Address Line | 10050 AUBURN PARK DR
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City | FORT WAYNE
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State | IN
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Zip | 46825-2389
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Country | US
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Telephone | 260-432-6459
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Fax | 260-240-5284
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | TL.0009112
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | TL.0009112
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 02008137A
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License Number State | IN
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