Provider Demographics
NPI:1275582512
Name:MUNIZ, ANTONIO M (MD)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:M
Last Name:MUNIZ
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 1:8317 ALEXANDRIA CT
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-3377
Mailing Address - Country:US
Mailing Address - Phone:941-924-1294
Mailing Address - Fax:
Practice Address - Street 1:5015 E BUSCH BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-5303
Practice Address - Country:US
Practice Address - Phone:813-985-2784
Practice Address - Fax:813-989-9129
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9863208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL58176WMedicare ID - Type Unspecified
FLD86083Medicare UPIN