Healthcare Provider Details

I. General information

NPI: 1427007582
Provider Name (Legal Business Name): MELVIN C BUNN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 E 87TH ST
CHICAGO IL
60619-7011
US

IV. Provider business mailing address

3601 W 183RD ST
HAZEL CREST IL
60429-2409
US

V. Phone/Fax

Practice location:
  • Phone: 773-602-7800
  • Fax:
Mailing address:
  • Phone: 708-957-7623
  • Fax: 708-957-7948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: