Provider Demographics
NPI:1770601080
Name:FRANSEN AND KULB UROLOGY, LTD
Entity type:Organization
Organization Name:FRANSEN AND KULB UROLOGY, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF THE CORPORATION
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KULB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-663-9424
Mailing Address - Street 1:1401 EASTLAND DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-3514
Mailing Address - Country:US
Mailing Address - Phone:309-663-9424
Mailing Address - Fax:
Practice Address - Street 1:2100 FORT JESSE RD
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-9370
Practice Address - Country:US
Practice Address - Phone:309-834-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL7002512261QL0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QL0400XAmbulatory Health Care FacilitiesClinic/CenterLithotripsy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00100008OtherRR MEDICARE PROVIDER #
IL0723870001OtherDURABLE MEDICAL PROVIDER
IL5732045OtherBCBS PROVIDER #
ILP00100008OtherRR MEDICARE PROVIDER #
ILI02495Medicare UPIN
ILC48946Medicare UPIN
ILG14718Medicare UPIN