Healthcare Provider Details

I. General information

NPI: 1124449681
Provider Name (Legal Business Name): MICHAEL PLUNKETT, MDSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2013
Last Update Date: 01/13/2020
Certification Date: 01/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7447 W TALCOTT AVE STE 182
CHICAGO IL
60631-3712
US

IV. Provider business mailing address

7447 W TALCOTT AVE STE 182
CHICAGO IL
60631-3712
US

V. Phone/Fax

Practice location:
  • Phone: 773-792-5155
  • Fax: 773-594-7975
Mailing address:
  • Phone: 773-792-5155
  • Fax: 773-594-7975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: MICHAEL J PLUNKETT
Title or Position: PRESIDENT
Credential: MD
Phone: 773-792-5155