Healthcare Provider Details

I. General information

NPI: 1073530572
Provider Name (Legal Business Name): EMILY S JUNGHEIM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 01/10/2020
Certification Date: 01/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 E ERIE ST STE 2400
CHICAGO IL
60611-3907
US

IV. Provider business mailing address

259 E ERIE ST STE 2400
CHICAGO IL
60611-3907
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-7269
  • Fax:
Mailing address:
  • Phone: 312-695-7269
  • Fax: 312-695-4924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number2005006932
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: