NPI Code Detail JSON Logo

1801847835 NPI number — MARK JUNDANIAN MD

NPI Number: 1801847835
Health Care Provider/Practitioner: MARK JUNDANIAN MD

Information about “1801847835” NPI (MARK JUNDANIAN MD) exists in 1801847835 in HTML format HTML  |  1801847835 in plain Text format TXT  |  1801847835 in PDF (Portable Document Format) PDF  |  1801847835 in an XML format XML  formats.

NPI Number : 1801847835 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1801847835",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "JUNDANIAN",
    "FirstName": "MARK",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2900 N LAKE SHORE DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHICAGO",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60657-5640",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "773-665-3240",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "903 COMMERCE",
    "SecondLinePracticeLocationAddress": "SUITE 333",
    "PracticeLocationAddressCityName": "CHICAGO",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60523-8723",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "773-484-4105",
    "PracticeLocationAddressFaxNumber": "773-484-4154",
    "EnumerationDate": "05/15/2006",
    "LastUpdateDate": "06/20/2012",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "2085R0202X",
        "TaxonomyName": "Diagnostic Radiology Physician",
        "LicenseNumber": "036-073397",
        "LicenseNumberStateCode": "IL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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