Healthcare Provider Details

I. General information

NPI: 1689060188
Provider Name (Legal Business Name): LOREN NUNLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2015
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 W VAN BUREN ST UNIT 555N
CHICAGO IL
60607-0433
US

IV. Provider business mailing address

PO BOX 8209
VIENNA VA
22183-2058
US

V. Phone/Fax

Practice location:
  • Phone: 855-479-4217
  • Fax: 888-557-9724
Mailing address:
  • Phone: 855-479-4217
  • Fax: 888-557-9724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number69069-20
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number036-1538190
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: