Healthcare Provider Details

I. General information

NPI: 1336235670
Provider Name (Legal Business Name): HENRY SON MUNEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 12/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 N FRANCISCO AVE
CHICAGO IL
60622-2743
US

IV. Provider business mailing address

1522 W CHICAGO AVE
CHICAGO IL
60622-5236
US

V. Phone/Fax

Practice location:
  • Phone: 773-292-8254
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number36-45297
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: