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General NPI Number Information
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NPI Number | 1346430832
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Entity Type | Organization
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Legal Business Name | MUNCIE FAMILY MEDICINE
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Dates
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Enumeration Date | 07/31/2007
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Last Update Date | 07/31/2007
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Provider Practice Location Address
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Address Line | 503 S TILLOTSON AVE
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City | MUNCIE
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State | IN
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Zip | 47304-4447
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Country | US
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Telephone | 765-213-2234
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Fax | 765-282-5231
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Provider Business Mailing Address
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Address Line | 503 S TILLOTSON AVE
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City | MUNCIE
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State | IN
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Zip | 47304-4447
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Country | US
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Telephone | 765-213-2234
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Fax | 765-282-5231
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JEFFREY BRUCE HILTZ
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Credential | M.D.
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Telephone | 765-213-2234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | 01042668
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License Number State | IN
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