Healthcare Provider Details

I. General information

NPI: 1922413335
Provider Name (Legal Business Name): ERIC DANIEL JUNG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2014
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 JOLIET ST
DYER IN
46311-1705
US

IV. Provider business mailing address

4531 FOREST AVE
BROOKFIELD IL
60513-2506
US

V. Phone/Fax

Practice location:
  • Phone: 219-865-2141
  • Fax: 219-852-2502
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036148212
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036148212
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: