Provider Demographics
NPI:1417077603
Name:MUNJAL, JITENDER (MD)
Entity Type:Individual
Prefix:
First Name:JITENDER
Middle Name:
Last Name:MUNJAL
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 1:3709 N CAMPBELL AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-1563
Mailing Address - Country:US
Mailing Address - Phone:520-838-2122
Mailing Address - Fax:520-838-2245
Practice Address - Street 1:6565 E CARONDELET DR STE 301
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-2159
Practice Address - Country:US
Practice Address - Phone:520-838-3540
Practice Address - Fax:520-324-3526
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ55207207RC0001X
OH35088205207R00000X, 207RC0000X
OH35 088205207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3003636Medicaid
AZ332319Medicaid