MEDICARE: MARCELO N MUNOZ M.D.

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
1	207Y00000X	Otolaryngology Physician		IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00158604	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0021602771	OTHER	IL	BLUE SHIELD

General Provider Information

NPI Number	:	1093704157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCELO N MUNOZ M.D.

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

Provider Business Practice Location Address
First Line	:	2222 W DIVISION ST
Second Line	:	SUITE 230
City	:	CHICAGO
State	:	IL
Zip	:	60622-2717
Country	:	US
Telephone Number	:	773-342-0993
Fax Number	:	773-342-0996

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	07/08/2007

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Directions to “ MARCELO N MUNOZ M.D.” Practice Location

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