Individual
DR. PAK K FUNG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
405 W JACKSON ST, CARBONDALE, IL 62901-1462
(618) 549-0721
Mailing address
110 HALEIGH DRIVE, ENERGY, IL 62933
(618) 727-3864
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036-079290
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036079290
—
IL
05
—
036079290-3
—
IL
05
—
036079290-6
—
IL
01
—
3932056
BLUE SHIELD
IL
05
—
7100150560
—
KY
Enumeration date
05/23/2006
Last updated
03/08/2011
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