Provider Demographics
NPI:1033199336
Name:PUNDY, ANDREW B (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:B
Last Name:PUNDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1875 DEMPSTER ST STE 504
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1130
Mailing Address - Country:US
Mailing Address - Phone:847-518-8490
Mailing Address - Fax:847-518-8492
Practice Address - Street 1:1875 DEMPSTER
Practice Address - Street 2:SUITE 490
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1120
Practice Address - Country:US
Practice Address - Phone:847-518-8490
Practice Address - Fax:847-518-8492
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL0360530812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
21607583OtherBL SHIELD
C42495Medicare UPIN
IL496750Medicare ID - Type Unspecified