Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 125058400 | IL |
Y | 207QA0401X | Family Doctor - Addiction Medicine | 036132644 | IL |
NPI | 1821319419 |
---|---|
Provider Name | Dr. Beth Dunlap |
First Address | Chicago, IL 60645-3502 |
Second Address | Chicago, IL 60611-4494 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2010 |
Last Update Date | 04/02/2020 |