Healthcare Provider Details

I. General information

NPI: 1467392316
Provider Name (Legal Business Name): MURESUK MENA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 W BETHANY HOME RD
PHOENIX AZ
85015-2443
US

IV. Provider business mailing address

555 W KINZIE ST
CHICAGO IL
60654-5727
US

V. Phone/Fax

Practice location:
  • Phone: 602-249-0212
  • Fax:
Mailing address:
  • Phone: 651-734-5034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: