Healthcare Provider Details

I. General information

NPI: 1104320381
Provider Name (Legal Business Name): JUSTIN SPRING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 06/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 E HURON ST
CHICAGO IL
60611
US

IV. Provider business mailing address

712 W 176TH ST APT 2B
NEW YORK NY
10033-7520
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-2000
  • Fax:
Mailing address:
  • Phone: 978-413-9075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number125.073001
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: