Healthcare Provider Details

I. General information

NPI: 1396401022
Provider Name (Legal Business Name): MIU GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2021
Last Update Date: 06/14/2022
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 W TIMONIUM RD STE 305
LUTHERVILLE TIMONIUM MD
21093-3106
US

IV. Provider business mailing address

57 W TIMONIUM RD STE 305
LUTHERVILLE TIMONIUM MD
21093-3106
US

V. Phone/Fax

Practice location:
  • Phone: 860-573-8109
  • Fax:
Mailing address:
  • Phone: 443-275-2068
  • Fax: 833-907-2413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MUNACHIM UYANWUNE
Title or Position: OWNER
Credential: M.D.
Phone: 443-275-2068