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General NPI Number Information
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NPI Number | 1578841177
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Entity Type | Organization
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Legal Business Name | MUNOZ MEDICAL CENTER LLC
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Dates
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Enumeration Date | 07/30/2011
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Last Update Date | 08/28/2012
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Provider Practice Location Address
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Address Line | 5129 N AUSTIN AVE
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City | CHICAGO
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State | IL
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Zip | 60630-1902
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Country | US
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Telephone | 773-450-1952
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Fax | 708-447-3022
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Provider Business Mailing Address
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Address Line | 5129 N AUSTIN AVE
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City | CHICAGO
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State | IL
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Zip | 60630-1902
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Country | US
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Telephone | 773-450-1952
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Fax | 708-447-3022
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Authorized Official
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Title or Position | MANAGER
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Name | DR. VICTOR MUNOZ
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Credential | M.D.
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Telephone | 773-450-1952
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 036119790
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License Number State | IL
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