Provider Demographics
NPI:1124834403
Name:PUNKAY, MARC OSCAR
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:OSCAR
Last Name:PUNKAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 DAVIS ST # 200
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4491
Mailing Address - Country:US
Mailing Address - Phone:773-294-0176
Mailing Address - Fax:
Practice Address - Street 1:622 DAVIS ST # 200
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4491
Practice Address - Country:US
Practice Address - Phone:773-294-0176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health