Provider Demographics
NPI:1619647039
Name:FULFILL HEALTH
Entity Type:Organization
Organization Name:FULFILL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:RYNIEC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-699-5278
Mailing Address - Street 1:4520 PERSHING AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-2657
Mailing Address - Country:US
Mailing Address - Phone:630-699-5278
Mailing Address - Fax:
Practice Address - Street 1:1 TRANSAM PLAZA DR STE 220
Practice Address - Street 2:
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-4285
Practice Address - Country:US
Practice Address - Phone:630-839-9199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty