MEDICARE: DR. ERIC JAMES KUNATH DDS

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	122300000X	Dentist	019.027729	IL
2	1223E0200X	Endodontics	021.002308	IL

General Provider Information

NPI Number	:	1902885916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC JAMES KUNATH DDS

Provider Business Mailing Address
First Line	:	25 E WASHINGTON ST
Second Line	:	SUITE 1921
City	:	CHICAGO
State	:	IL
Zip	:	60602-1708
Country	:	US
Telephone Number	:	312-782-8862
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 E WASHINGTON ST
Second Line	:	SUITE 1921
City	:	CHICAGO
State	:	IL
Zip	:	60602-1708
Country	:	US
Telephone Number	:	312-782-8862
Fax Number	:

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

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	07/26/2010

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