Provider Demographics
NPI:1225219561
Name:MUNGER, MARKUS M
Entity Type:Individual
Prefix:MR
First Name:MARKUS
Middle Name:M
Last Name:MUNGER
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 1:4351 24TH AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FORT GRATIOT
Mailing Address - State:MI
Mailing Address - Zip Code:48059-4506
Mailing Address - Country:US
Mailing Address - Phone:810-385-7405
Mailing Address - Fax:810-385-7420
Practice Address - Street 1:4351 24TH AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:FORT GRATIOT
Practice Address - State:MI
Practice Address - Zip Code:48059-4506
Practice Address - Country:US
Practice Address - Phone:810-385-7405
Practice Address - Fax:810-385-7420
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-15
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI004051225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI65-0-G4-1223-0OtherBLUE CROSS AND BLUE SHIELD
MI65-0-G4-1223-0OtherBLUE CROSS AND BLUE SHIELD