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NPI Code Detail

MEDICARE: DR. ANDREW QUINBY DEFUNIAK M.D.

MEDICARE: DR. ANDREW QUINBY DEFUNIAK M.D.
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
1207Q00000XFamily Medicine Physician036-107970IL

General Provider Information

NPI Number : 1508951351
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANDREW QUINBY DEFUNIAK M.D.
Provider Business Mailing Address
First Line : 5245 N MAGNOLIA AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60640-2202
Country : US
Telephone Number : 773-869-7488
Fax Number : 773-869-3578
Provider Business Practice Location Address
First Line : 2800 S CALIFORNIA AVE
Second Line : MED/SURG OFFICE
City : CHICAGO
State : IL
Zip : 60608-5107
Country : US
Telephone Number : 773-869-7488
Fax Number : 773-869-3578
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2006
Last Update Date : 04/22/2021

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