Healthcare Provider Details

I. General information

NPI: 1962969881
Provider Name (Legal Business Name): MONIQUE MUNRO M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2019
Last Update Date: 10/23/2019
Certification Date:
Deactivation Date: 10/09/2019
Reactivation Date: 10/22/2019

III. Provider practice location address

1855 W TAYLOR STREET. SUITE 3138 ILLINOIS EYE AND INFIR
CHICAGO IL
60612
US

IV. Provider business mailing address

1855 WEST TAYLOR STREET SUITE 3138
CHICAGO IL
60612
US

V. Phone/Fax

Practice location:
  • Phone: 312-966-6660
  • Fax: 312-996-6572
Mailing address:
  • Phone: 312-468-6031
  • Fax: 312-996-7770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateZZ
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number036.149392
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: