Provider Demographics
NPI:1801102322
Name:DUNKLEYSHURTS, KARISSA MARIE (DO)
Entity type:Individual
Prefix:DR
First Name:KARISSA
Middle Name:MARIE
Last Name:DUNKLEYSHURTS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2865 N CLYBOURN AVE
Mailing Address - Street 2:NUMBER 3
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-8269
Mailing Address - Country:US
Mailing Address - Phone:720-939-5432
Mailing Address - Fax:
Practice Address - Street 1:2865 N CLYBOURN AVE
Practice Address - Street 2:NUMBER 3
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-8269
Practice Address - Country:US
Practice Address - Phone:720-939-5432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-21
Last Update Date:2010-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125055067207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery