Organization
FOND DU LAC PSYCHIATRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY THOMAS JUNIG MD PHD (OWNER)
(920) 923-9054
Entity
Organization
Contact information
Practice address
1020 S MAIN ST, SUITE A, FOND DU LAC, WI 54935-6102
(920) 923-9054
(920) 322-9193
Mailing address
1020 S MAIN ST, SUITE A, FOND DU LAC, WI 54935-6102
(920) 923-9054
(920) 322-9193
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
32668-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31769900
—
WI
Enumeration date
01/05/2009
Last updated
01/05/2009
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