MEDICARE: DR. BETH DUNLAP MD

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	207QA0401X	Addiction Medicine (Family Medicine) Physician	036132644	IL
2	207Q00000X	Family Medicine Physician	125058400	IL

General Provider Information

NPI Number	:	1821319419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BETH DUNLAP MD

Provider Business Mailing Address
First Line	:	2120 W ESTES AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-3502
Country	:	US
Telephone Number	:	773-576-2292
Fax Number	:

Provider Business Practice Location Address
First Line	:	420 E SUPERIOR ST
Second Line	:	STE 12
City	:	CHICAGO
State	:	IL
Zip	:	60611-4494
Country	:	US
Telephone Number	:	312-503-7975
Fax Number	:

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

Provider Enumeration Date	:	06/17/2010
Last Update Date	:	02/04/2020

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