MEDICARE: MICHAEL JUNG M.D.

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	208VP0000X	Pain Medicine Physician	53681-20	WI

General Provider Information

NPI Number	:	1861665747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL JUNG M.D.

Provider Business Mailing Address
First Line	:	DEPT CH 17057
Second Line	:
City	:	PALATINE
State	:	IL
Zip	:	60055-7057
Country	:	US
Telephone Number	:	920-204-6758
Fax Number	:	888-720-0495

Provider Business Practice Location Address
First Line	:	1000 GATEWAY CT STE 100
Second Line	:
City	:	WEST BEND
State	:	WI
Zip	:	53095-8541
Country	:	US
Telephone Number	:	920-204-6758
Fax Number	:

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

Provider Enumeration Date	:	04/10/2008
Last Update Date	:	12/21/2021

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