Healthcare Provider Details

I. General information

NPI: 1659136752
Provider Name (Legal Business Name): JESUS MOISES MUNOZ PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MR. JESUS MOISES MUNOZ

II. Dates (important events)

Enumeration Date: 02/19/2024
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 E HURON ST STE 16-738
CHICAGO IL
60611-2908
US

IV. Provider business mailing address

251 E HURON ST STE 16-738
CHICAGO IL
60611-2908
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-5924
  • Fax: 312-926-6134
Mailing address:
  • Phone: 312-926-5924
  • Fax: 312-926-6134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number10004675A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085011908
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10004675A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: