Provider Demographics
NPI:1235219825
Name:MUNNEKE, JOHN ALBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALBERT
Last Name:MUNNEKE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:36 W MEMORIAL RD
Mailing Address - Street 2:SUITE C3
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-2312
Mailing Address - Country:US
Mailing Address - Phone:405-755-9702
Mailing Address - Fax:405-755-9718
Practice Address - Street 1:36 W MEMORIAL RD
Practice Address - Street 2:SUITE C3
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-2312
Practice Address - Country:US
Practice Address - Phone:405-755-9702
Practice Address - Fax:405-755-9718
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK112272083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKC95280Medicare UPIN