Provider Demographics
NPI:1366409823
Name:JUNIG, JEFFREY T (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:T
Last Name:JUNIG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-6102
Mailing Address - Country:US
Mailing Address - Phone:920-923-9054
Mailing Address - Fax:920-322-9193
Practice Address - Street 1:1020 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-6102
Practice Address - Country:US
Practice Address - Phone:920-923-9054
Practice Address - Fax:920-322-9193
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI326682084P2900X
WI32668-0202084P0800X, 2084A0401X, 2084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31769900Medicaid
WI32668-020OtherMEDICAL LICENSE
WI31769900Medicaid