Provider Demographics
NPI:1801847835
Name:JUNDANIAN, MARK (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:JUNDANIAN
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 1:2900 N LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5640
Mailing Address - Country:US
Mailing Address - Phone:773-665-3240
Mailing Address - Fax:
Practice Address - Street 1:903 COMMERCE
Practice Address - Street 2:SUITE 333
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60523-8723
Practice Address - Country:US
Practice Address - Phone:773-484-4105
Practice Address - Fax:773-484-4154
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0733972085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F27606Medicare UPIN