Provider Demographics
NPI:1144970575
Name:FUNFROCK, JULIE ANN (DO)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:FUNFROCK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:WEILBAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10050 AUBURN PARK DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-2389
Mailing Address - Country:US
Mailing Address - Phone:260-432-6459
Mailing Address - Fax:260-240-5284
Practice Address - Street 1:10050 AUBURN PARK DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-2389
Practice Address - Country:US
Practice Address - Phone:260-432-6459
Practice Address - Fax:260-240-5284
Is Sole Proprietor?:No
Enumeration Date:2022-03-28
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COTL.0009112207Q00000X, 390200000X
IN02008137A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program