Provider Demographics
NPI:1326048976
Name:MUNIM, MASROOR (MD)
Entity Type:Individual
Prefix:
First Name:MASROOR
Middle Name:
Last Name:MUNIM
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 1:7200 W GREENFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214-4710
Mailing Address - Country:US
Mailing Address - Phone:414-543-1441
Mailing Address - Fax:414-543-1521
Practice Address - Street 1:7200 W GREENFIELD AVE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-4710
Practice Address - Country:US
Practice Address - Phone:414-543-1441
Practice Address - Fax:414-543-1521
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI37915207R00000X, 207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI110237343OtherRAILROAD MEDICARE
WI32248500Medicaid
G73295Medicare UPIN
WI000002719Medicare PIN