Healthcare Provider Details

I. General information

NPI: 1487351557
Provider Name (Legal Business Name): BRADY HUNTER BUNKELMAN MS, CGC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2023
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 DEMPSTER ST # S285
PARK RIDGE IL
60068-1186
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-6164
US

V. Phone/Fax

Practice location:
  • Phone: 847-723-7705
  • Fax:
Mailing address:
  • Phone: 847-390-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number246.000805
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: