MEDICARE: JAVIER MUNIZ, DO, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	036097846	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	110245013	OTHER	IL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	385740	OTHER	IL	HEALTHLINK
2	39692	OTHER	IL	HEALTH ALLIANCE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	10032009	OTHER	IL	BCBS
5	101436	OTHER	IL	BLACK LUNG

General Provider Information

NPI Number	:	1700807575
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAVIER MUNIZ, DO, LLC

Provider Business Mailing Address
First Line	:	315 S 13TH ST
Second Line	:	SUITE 2
City	:	HERRIN
State	:	IL
Zip	:	62948-3619
Country	:	US
Telephone Number	:	618-942-5883
Fax Number	:	618-942-5921

Provider Business Practice Location Address
First Line	:	315 S 13TH ST
Second Line	:	SUITE 2
City	:	HERRIN
State	:	IL
Zip	:	62948-3619
Country	:	US
Telephone Number	:	618-942-5883
Fax Number	:	618-942-5921

Authorized Official
Title or Position	:	OWNER
Name	:	JAVIER MUNIZ
Credential	:	DO
Telephone Number	:	618-942-5883

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	07/11/2012

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Directions to “JAVIER MUNIZ, DO, LLC ” Practice Location

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