Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | 2005006932 | MO |
NPI | 1073530572 |
---|---|
Provider Name | Dr. Emily S Jungheim |
First Address | Chicago, IL 60611-3907 |
Second Address | Chicago, IL 60611-3907 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 10/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
209406602 | (05) | MO |
ENROLLED | (05) | IL |