Individual
DR. JONATHAN LEE MCJUNKIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3105 FIELDS SOUTH DR, CHAMPAIGN, IL 61822-3743
(217) 902-3277
(217) 383-4451
Mailing address
611 W PARK ST, FAPC, URBANA, IL 61801
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
036125895
IL
207Y00000X
Otolaryngology Physician
2011009453
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1336218643
—
MO
05
—
ENROLLED
—
IL
Enumeration date
11/08/2006
Last updated
02/26/2021
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