Healthcare Provider Details

I. General information

NPI: 1164452298
Provider Name (Legal Business Name): ANDREA L. MUNOZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13850 W CAPITOL DR
BROOKFIELD WI
53005-2422
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 262-790-1118
  • Fax: 262-790-2070
Mailing address:
  • Phone: 800-326-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34546
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: