Provider Demographics
NPI:1184679599
Name:MOYENUDDIN, MUNSHI (MD)
Entity Type:Individual
Prefix:DR
First Name:MUNSHI
Middle Name:
Last Name:MOYENUDDIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 E MARKET ST
Mailing Address - Street 2:PO BOX 3542
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44308-2038
Mailing Address - Country:US
Mailing Address - Phone:330-996-0347
Mailing Address - Fax:330-996-0359
Practice Address - Street 1:75 ARCH ST STE 506
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1434
Practice Address - Country:US
Practice Address - Phone:330-375-3894
Practice Address - Fax:330-375-6680
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-08-2737-M207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2413838Medicaid
OHBA9336331Medicare PIN
OHMO4112501Medicare PIN