Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | IL |
NPI | 1427007582 |
---|---|
Provider Name | Melvin C Bunn |
First Address | Hazel Crest, IL 60429-2409 |
Second Address | Chicago, IL 60619-7011 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D15070 | (02) | IL |