MEDICARE: MARK JUNDANIAN 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	2085R0202X	Diagnostic Radiology Physician	036-073397	IL

General Provider Information

NPI Number	:	1801847835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK JUNDANIAN MD

Provider Business Mailing Address
First Line	:	2900 N LAKE SHORE DR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-5640
Country	:	US
Telephone Number	:	773-665-3240
Fax Number	:

Provider Business Practice Location Address
First Line	:	903 COMMERCE
Second Line	:	SUITE 333
City	:	CHICAGO
State	:	IL
Zip	:	60523-8723
Country	:	US
Telephone Number	:	773-484-4105
Fax Number	:	773-484-4154

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

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	06/20/2012

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