Basic Information
| Provider Information | |||||||||
| NPI: | 1124449681 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MICHAEL PLUNKETT, MDSC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7447 W TALCOTT AVE STE 182 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606313712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7737925155 | ||||||||
| FaxNumber: | 7735947975 | ||||||||
| Practice Location | |||||||||
| Address1: | 7447 W TALCOTT AVE STE 182 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606313712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7737925155 | ||||||||
| FaxNumber: | 7735947975 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/30/2013 | ||||||||
| LastUpdateDate: | 01/13/2020 | ||||||||
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| AuthorizedOfficialLastName: | PLUNKETT | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7737925155 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 01/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | N | Ambulatory Health Care Facilities | Clinic/Center | Primary Care | 207R00000X | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.