Provider Demographics
NPI:1043239247
Name:MUNOZ, KRISHNAMURTI (DO)
Entity Type:Individual
Prefix:
First Name:KRISHNAMURTI
Middle Name:
Last Name:MUNOZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 WEST WASHINGTON STREET #1006
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606
Mailing Address - Country:US
Mailing Address - Phone:305-793-0324
Mailing Address - Fax:
Practice Address - Street 1:208 W WASHINGTON ST APT 1006
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-3574
Practice Address - Country:US
Practice Address - Phone:305-793-0324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0115969207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-0115969OtherSTATE LICENSE