Provider Demographics
NPI:1225023146
Name:FULLOP, JULKO E (MD)
Entity Type:Individual
Prefix:
First Name:JULKO
Middle Name:E
Last Name:FULLOP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1527 COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT CARMEL
Mailing Address - State:IL
Mailing Address - Zip Code:62863-2615
Mailing Address - Country:US
Mailing Address - Phone:618-263-6400
Mailing Address - Fax:618-263-6291
Practice Address - Street 1:120 JAQUESS AVE
Practice Address - Street 2:
Practice Address - City:MOUNT CARMEL
Practice Address - State:IL
Practice Address - Zip Code:62863-1211
Practice Address - Country:US
Practice Address - Phone:618-262-2390
Practice Address - Fax:618-262-2393
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036113111207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036113111Medicaid
I32037Medicare UPIN
K18392Medicare ID - Type Unspecified