Healthcare Provider Details

I. General information

NPI: 1902898901
Provider Name (Legal Business Name): DONALD G MUNSON PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 12/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 BARNHILL DR. EH 215
INDIANAPOLIS IN
46202-5112
US

IV. Provider business mailing address

P.O. BOX 636762
CINCINNATI OH
45263-0001
US

V. Phone/Fax

Practice location:
  • Phone: 317-274-7728
  • Fax:
Mailing address:
  • Phone: 317-274-7728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10000156A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: