Provider Demographics
NPI:1639327828
Name:MULFORD MEDICAL LLC
Entity type:Organization
Organization Name:MULFORD MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:H
Authorized Official - Last Name:SCHOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:815-229-9900
Mailing Address - Street 1:657 S MULFORD RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-2533
Mailing Address - Country:US
Mailing Address - Phone:815-229-9900
Mailing Address - Fax:815-229-9953
Practice Address - Street 1:657 S MULFORD RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2533
Practice Address - Country:US
Practice Address - Phone:815-229-9900
Practice Address - Fax:815-229-9953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036096167207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty