MEDICARE: DR. ARTHUR DOMINIC FUNK 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
1	207R00000X	Internal Medicine Physician		IL

General Provider Information

NPI Number	:	1750573465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ARTHUR DOMINIC FUNK M.D.

Provider Business Mailing Address
First Line	:	1335 S PRAIRIE AVE
Second Line	:	#403
City	:	CHICAGO
State	:	IL
Zip	:	60605-3121
Country	:	US
Telephone Number	:	312-945-3611
Fax Number	:	312-945-3622

Provider Business Practice Location Address
First Line	:	1335 S PRAIRIE AVE
Second Line	:	#403
City	:	CHICAGO
State	:	IL
Zip	:	60605-3121
Country	:	US
Telephone Number	:	312-945-3611
Fax Number	:	312-945-3622

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

Provider Enumeration Date	:	08/16/2007
Last Update Date	:	08/16/2007

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