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General NPI Number Information
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NPI Number | 1942505664
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Entity Type | Organization
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Legal Business Name | FRIEDRICH J. VON BUN, M.D.,S.C.
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Dates
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Enumeration Date | 01/12/2011
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Last Update Date | 01/12/2011
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Provider Practice Location Address
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Address Line | 1327 EXECUTIVE CT
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City | PEKIN
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State | IL
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Zip | 61554-6096
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Country | US
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Telephone | 309-353-5864
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Fax | 309-353-4894
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Provider Business Mailing Address
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Address Line | 1327 EXECUTIVE CT
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City | PEKIN
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State | IL
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Zip | 61554-6096
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Country | US
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Telephone | 309-353-5864
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. FRIEDRICH JOSEF VON BUN
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Credential | M.D.
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Telephone | 309-353-5864
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 24781673
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License Number State | IL
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