Provider Demographics
NPI:1366563256
Name:NICHOLAS DUNKAS MD AND ASSOCIATES
Entity type:Organization
Organization Name:NICHOLAS DUNKAS MD AND ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNKAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-864-4744
Mailing Address - Street 1:708 CHURCH ST
Mailing Address - Street 2:SUITE 216
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-3875
Mailing Address - Country:US
Mailing Address - Phone:847-864-4744
Mailing Address - Fax:847-864-9523
Practice Address - Street 1:708 CHURCH ST
Practice Address - Street 2:SUITE 216
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3875
Practice Address - Country:US
Practice Address - Phone:847-864-4744
Practice Address - Fax:847-864-9523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherTAX ID
IL=========OtherTAX ID