Healthcare Provider Details

I. General information

NPI: 1366409823
Provider Name (Legal Business Name): JEFFREY T JUNIG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 12/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 S MAIN ST
FOND DU LAC WI
54935-6102
US

IV. Provider business mailing address

1020 S MAIN ST
FOND DU LAC WI
54935-6102
US

V. Phone/Fax

Practice location:
  • Phone: 920-923-9054
  • Fax: 920-322-9193
Mailing address:
  • Phone: 920-923-9054
  • Fax: 920-322-9193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number32668
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number32668-020
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number32668-020
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number32668-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: