Provider Demographics
NPI:1942505664
Name:FRIEDRICH J. VON BUN, M.D.,S.C.
Entity Type:Organization
Organization Name:FRIEDRICH J. VON BUN, M.D.,S.C.
Other - Org Name:PEKIN PULMONARY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRIEDRICH
Authorized Official - Middle Name:JOSEF
Authorized Official - Last Name:VON BUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-353-5864
Mailing Address - Street 1:1327 EXECUTIVE CT
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-6096
Mailing Address - Country:US
Mailing Address - Phone:309-353-5864
Mailing Address - Fax:
Practice Address - Street 1:1327 EXECUTIVE CT
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-6096
Practice Address - Country:US
Practice Address - Phone:309-353-5864
Practice Address - Fax:309-353-4894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-12
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL24781673261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
1760489306OtherNPI
IL0360812671Medicaid
290008130OtherRAILROAD MEDICARE
944370OtherPTAN
E47885Medicare UPIN