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NPI Code Detail

MEDICARE: SAMUEL ROBERT BUNTING

MEDICARE: SAMUEL ROBERT BUNTING
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
12084P0800XPsychiatry Physician036168204IL
2207RI0200XInfectious Disease Physician036168204IL

General Provider Information

NPI Number : 1144801408
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMUEL ROBERT BUNTING
Provider Business Mailing Address
First Line : 150 HARVESTER DR STE 300
Second Line :
City : BURR RIDGE
State : IL
Zip : 60527-5965
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5841 S MARYLAND AVE # MC3077
Second Line :
City : CHICAGO
State : IL
Zip : 60637-1443
Country : US
Telephone Number : 773-834-0373
Fax Number : 773-702-4297
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2021
Last Update Date : 01/21/2026

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