Basic Information
| Provider Information | |||||||||
| NPI: | 1821319419 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUNLAP | ||||||||
| FirstName: | BETH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2120 W ESTES AVE | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606453502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7735762292 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 420 E SUPERIOR ST | ||||||||
| Address2: | STE 12 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606114494 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3125037975 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2010 | ||||||||
| LastUpdateDate: | 02/04/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QA0401X | 036132644 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine | Addiction Medicine | 207Q00000X | 125058400 | IL | N | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.