MEDICARE: DONALD G MUNSON PA

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	363A00000X	Physician Assistant	10000156A	IN

General Provider Information

NPI Number	:	1902898901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONALD G MUNSON PA

Provider Business Mailing Address
First Line	:	P.O. BOX 636762
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-0001
Country	:	US
Telephone Number	:	317-274-7728
Fax Number	:

Provider Business Practice Location Address
First Line	:	545 BARNHILL DR.
Second Line	:	EH 215
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-5112
Country	:	US
Telephone Number	:	317-274-7728
Fax Number	:

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

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	12/07/2012

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