MEDICARE: FIRST HEALTH, INC.

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	102L00000X	Psychoanalyst		IL

General Provider Information

NPI Number	:	1881804037
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST HEALTH, INC.

Provider Business Mailing Address
First Line	:	6038 S CHAMPLAIN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60637-2512
Country	:	US
Telephone Number	:	177-368-4633
Fax Number	:	177-368-4637

Provider Business Practice Location Address
First Line	:	6038 S CHAMPLAIN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60637-2512
Country	:	US
Telephone Number	:	177-368-4633
Fax Number	:	177-368-4637

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ANDRE LARUE DUNIGAN
Credential	:	M.D.
Telephone Number	:	17736846339

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	08/22/2020

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