Healthcare Provider Details

I. General information

NPI: 1316055023
Provider Name (Legal Business Name): PUNEET OPAL MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 N LAKE SHORE DR SUITE 1000
CHICAGO IL
60611-4546
US

IV. Provider business mailing address

303 E CHICAGO AVE WARD 10-332
CHICAGO IL
60611-3093
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-9797
  • Fax: 312-503-0872
Mailing address:
  • Phone: 312-503-4699
  • Fax: 312-503-0872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: