Healthcare Provider Details

I. General information

NPI: 1780211862
Provider Name (Legal Business Name): ALEXIS DUNNING MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N MICHIGAN AVE STE 300
CHICAGO IL
60602-4495
US

IV. Provider business mailing address

1728 W DIVISION ST APT 401
CHICAGO IL
60622-3361
US

V. Phone/Fax

Practice location:
  • Phone: 312-726-3917
  • Fax:
Mailing address:
  • Phone: 614-832-7980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number125.077015
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036169836
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: