Provider Demographics
NPI:1073515086
Name:MUNIR, IRFAN
Entity Type:Individual
Prefix:
First Name:IRFAN
Middle Name:
Last Name:MUNIR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W 22ND ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1563
Mailing Address - Country:US
Mailing Address - Phone:630-575-5000
Mailing Address - Fax:
Practice Address - Street 1:11104 PARKVIEW CIRCLE DR
Practice Address - Street 2:ENTRANCE 11, SUITE 330
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1730
Practice Address - Country:US
Practice Address - Phone:260-494-3484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.077173207RN0300X
IN01050984A207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000095600OtherBCBS
IN200346200CMedicaid
OH2187815Medicaid
IN000000095600OtherBCBS
OHNE9277881-MU4028401Medicare PIN
IN390007835Medicare PIN
IN628850KMedicare PIN
IN200346200CMedicaid
OHNE9277883-MU4028401Medicare PIN
IN390007895Medicare ID - Type UnspecifiedRR
OHNE9277882- MU4028401Medicare PIN
INCA5480Medicare PIN