Provider Demographics
NPI:1477500486
Name:UNTI, JAMES A (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:UNTI
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:PO BOX 636
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-0636
Mailing Address - Country:US
Mailing Address - Phone:773-880-6040
Mailing Address - Fax:773-880-6107
Practice Address - Street 1:830 W DIVERSEY PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1454
Practice Address - Country:US
Practice Address - Phone:773-880-6040
Practice Address - Fax:773-880-6107
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036071149208C00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036071149Medicaid
IL020026554OtherMEDICARE RAILROAD PART B
IL0001618161OtherBCBS OF IL GROUP NUMBER
ILP12410Medicare PIN
IL0001618161OtherBCBS OF IL GROUP NUMBER
IL020026554OtherMEDICARE RAILROAD PART B