Healthcare Provider Details

I. General information

NPI: 1528321494
Provider Name (Legal Business Name): MUHAMMAD MUNEEB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2012
Last Update Date: 11/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

932 E 34TH ST
JOPLIN MO
64804-3932
US

IV. Provider business mailing address

PO BOX 3810
JOPLIN MO
64803-3810
US

V. Phone/Fax

Practice location:
  • Phone: 417-347-8570
  • Fax:
Mailing address:
  • Phone: 513-558-5471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number9407966
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number33582
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number2017010070
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: