Provider Demographics
NPI:1144230756
Name:PLUNKETT, MICHAEL J (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:PLUNKETT
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 1:7447 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:773-791-5155
Mailing Address - Fax:773-792-5155
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:773-925-1557
Practice Address - Fax:773-594-7975
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036047714207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-047714Medicaid
ILL82753OtherMEDICARE OTHER
IL036-047714Medicaid
K16354Medicare ID - Type Unspecified