Provider Demographics
NPI:1417020728
Name:MILLUNCHICK, EDWARD W (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:W
Last Name:MILLUNCHICK
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 1:12465 COPPER LN
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-6422
Mailing Address - Country:US
Mailing Address - Phone:224-858-4391
Mailing Address - Fax:
Practice Address - Street 1:12465 COPPER LN
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142-6422
Practice Address - Country:US
Practice Address - Phone:224-858-4391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2009-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA55617208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics