Provider Demographics
NPI:1508951351
Name:DEFUNIAK, ANDREW QUINBY (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:QUINBY
Last Name:DEFUNIAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5245 N MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-2202
Mailing Address - Country:US
Mailing Address - Phone:773-869-7488
Mailing Address - Fax:773-869-3578
Practice Address - Street 1:2800 S CALIFORNIA AVE
Practice Address - Street 2:MED/SURG OFFICE
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-5107
Practice Address - Country:US
Practice Address - Phone:773-869-7488
Practice Address - Fax:773-869-3578
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-107970207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine