MEDICARE: DR. DENISE RENEE CUNILL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	036-105752	IL

General Provider Information

NPI Number	:	1144233263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENISE RENEE CUNILL MD

Provider Business Mailing Address
First Line	:	2840 W FULLERTON AVE
Second Line	:	LOGAN SQUARE HEALTH CENTER OF COOK COUNTY
City	:	CHICAGO
State	:	IL
Zip	:	60647-2938
Country	:	US
Telephone Number	:	773-395-2966
Fax Number	:	773-395-9608

Provider Business Practice Location Address
First Line	:	2840 W FULLERTON AVE
Second Line	:	LOGAN SQUARE HEALTH CENTER OF COOK COUNTY
City	:	CHICAGO
State	:	IL
Zip	:	60647-2938
Country	:	US
Telephone Number	:	773-395-2966
Fax Number	:	773-395-9608

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	04/22/2021

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