Basic Information
| Provider Information | |||||||||
| NPI: | 1366409823 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JUNIG | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1020 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | FOND DU LAC | ||||||||
| State: | WI | ||||||||
| PostalCode: | 549356102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9209239054 | ||||||||
| FaxNumber: | 9203229193 | ||||||||
| Practice Location | |||||||||
| Address1: | 1020 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | FOND DU LAC | ||||||||
| State: | WI | ||||||||
| PostalCode: | 549356102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9209239054 | ||||||||
| FaxNumber: | 9203229193 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2006 | ||||||||
| LastUpdateDate: | 12/14/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P2900X | 32668 | WI | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Pain Medicine | 2084P0800X | 32668-020 | WI | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084A0401X | 32668-020 | WI | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Medicine | 2084F0202X | 32668-020 | WI | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Forensic Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 31769900 | 05 | WI | MEDICAID | 32668-020 | 01 | WI | MEDICAL LICENSE | OTHER |