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NPI Code Detail

MEDICARE: MIRANDA LOU MUNDAY MD

MEDICARE: MIRANDA LOU MUNDAY MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics PhysicianR3333KY
2208000000XPediatrics Physician48854KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1083059711
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIRANDA LOU MUNDAY MD
Provider Business Mailing Address
First Line : 303 S 4TH ST
Second Line :
City : DANVILLE
State : KY
Zip : 40422-2091
Country : US
Telephone Number : 859-236-1080
Fax Number :
Provider Business Practice Location Address
First Line : 303 S 4TH ST
Second Line :
City : DANVILLE
State : KY
Zip : 40422-2091
Country : US
Telephone Number : 859-236-1080
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2013
Last Update Date : 10/04/2018

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Directions to “ MIRANDA LOU MUNDAY MD” Practice Location

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