Organization
DEFINED LJ, INC
Active
Other names
DEFINED LJ, INC
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH MUNNERLYN MD (PRESIDENT)
(773) 730-7374
Entity
Organization
Contact information
Practice address
2623 N CLARK ST, CHICAGO, IL 60614-1524
(312) 722-6977
Mailing address
2623 N CLARK ST, CHICAGO, IL 60614-1524
(123) 722-6977
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Enumeration date
10/27/2021
Last updated
09/29/2023
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