Healthcare Provider Details

I. General information

NPI: 1235113234
Provider Name (Legal Business Name): SANDEEP MUNJAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 01/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 10TH STREET SE
CEDAR RAPIDS IA
52403-2404
US

IV. Provider business mailing address

PO BOX 3178
CEDAR RAPIDS IA
52406-3178
US

V. Phone/Fax

Practice location:
  • Phone: 319-398-1545
  • Fax: 319-399-2039
Mailing address:
  • Phone: 319-398-1583
  • Fax: 319-399-2085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number36167
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number036167
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: