Healthcare Provider Details

I. General information

NPI: 1144233263
Provider Name (Legal Business Name): DENISE RENEE CUNILL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 04/22/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2840 W FULLERTON AVE LOGAN SQUARE HEALTH CENTER OF COOK COUNTY
CHICAGO IL
60647-2938
US

IV. Provider business mailing address

2840 W FULLERTON AVE LOGAN SQUARE HEALTH CENTER OF COOK COUNTY
CHICAGO IL
60647-2938
US

V. Phone/Fax

Practice location:
  • Phone: 773-395-2966
  • Fax: 773-395-9608
Mailing address:
  • Phone: 773-395-2966
  • Fax: 773-395-9608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-105752
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: