1093704157 NPI number — MARCELO N MUNOZ M.D.

Table of content: MARCELO N MUNOZ M.D. (NPI 1093704157)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093704157 NPI number — MARCELO N MUNOZ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUNOZ
Provider First Name:
MARCELO
Provider Middle Name:
N
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093704157
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 388320
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60638-8320
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-767-8283
Provider Business Mailing Address Fax Number:
773-767-8320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2222 W DIVISION ST
Provider Second Line Business Practice Location Address:
SUITE 230
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60622-2717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-342-0993
Provider Business Practice Location Address Fax Number:
773-342-0996
Provider Enumeration Date:
10/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0021602771 . This is a "BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: P00158604 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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