Provider Demographics
NPI:1285827600
Name:HENRY SPUNAR
Entity Type:Organization
Organization Name:HENRY SPUNAR
Other - Org Name:HENRY SPUNAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:VAL
Authorized Official - Last Name:SPUNAR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:773-763-4788
Mailing Address - Street 1:6780 N NORTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-1201
Mailing Address - Country:US
Mailing Address - Phone:773-763-4788
Mailing Address - Fax:773-763-4174
Practice Address - Street 1:6780 N NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-1201
Practice Address - Country:US
Practice Address - Phone:773-763-4788
Practice Address - Fax:773-763-4174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1038550001Medicare NSC