Healthcare Provider Details

I. General information

NPI: 1689623761
Provider Name (Legal Business Name): DANIEL ANTHONY MUNIAK P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LEAVITT AVE
JORDAN MT
59337
US

IV. Provider business mailing address

602 MARGUERITE AVE
JORDAN MT
59337
US

V. Phone/Fax

Practice location:
  • Phone: 406-557-2499
  • Fax: 406-557-2950
Mailing address:
  • Phone: 406-557-2819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number359
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: