MEDICARE: ANDREW I. JUN 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	207Y00000X	Otolaryngology Physician	036104814	IL

General Provider Information

NPI Number	:	1841270717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW I. JUN MD

Provider Business Mailing Address
First Line	:	1235 N MULFORD RD
Second Line	:	STE 205
City	:	ROCKFORD
State	:	IL
Zip	:	61107-3879
Country	:	US
Telephone Number	:	815-484-9900
Fax Number	:	815-487-4949

Provider Business Practice Location Address
First Line	:	1235 N MULFORD RD
Second Line	:	STE 205
City	:	ROCKFORD
State	:	IL
Zip	:	61107-3879
Country	:	US
Telephone Number	:	815-484-9900
Fax Number	:	815-487-4949

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

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	01/30/2023

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