MEDICARE: MICHELLE A DUNKER PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	070018129	IL

General Provider Information

NPI Number	:	1114211257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE A DUNKER PT

Provider Business Mailing Address
First Line	:	421 W EXCHANGE ST
Second Line	:	PO BOX 268
City	:	FREEPORT
State	:	IL
Zip	:	61032-4008
Country	:	US
Telephone Number	:	815-599-7950
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 W MAIN ST
Second Line	:
City	:	LENA
State	:	IL
Zip	:	61048-9247
Country	:	US
Telephone Number	:	815-369-3300
Fax Number	:	815-369-4262

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2011
Last Update Date	:	07/16/2014

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Directions to “ MICHELLE A DUNKER PT” Practice Location

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