=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164452298
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREA L. MUNOZ M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/04/2006
-----------------------------------------------------
Last Update Date | 07/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13850 W CAPITOL DR
-----------------------------------------------------
City | BROOKFIELD
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53005-2422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-790-1118
-----------------------------------------------------
Fax | 262-790-2070
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 735044
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60673-5044
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-326-2250
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 34546
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------