Provider Demographics
NPI:1124449681
Name:MICHAEL PLUNKETT, MDSC
Entity type:Organization
Organization Name:MICHAEL PLUNKETT, MDSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:PLUNKETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-792-5155
Mailing Address - Street 1:7447 W TALCOTT AVE STE 182
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3712
Mailing Address - Country:US
Mailing Address - Phone:773-792-5155
Mailing Address - Fax:773-594-7975
Practice Address - Street 1:7447 W TALCOTT AVE STE 182
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3712
Practice Address - Country:US
Practice Address - Phone:773-792-5155
Practice Address - Fax:773-594-7975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-30
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2300X
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty