Provider Demographics
NPI:1457312449
Name:MUND, MICHAEL L (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:L
Last Name:MUND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1187 MAIN AVE
Mailing Address - Street 2:STE. 1F
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-2252
Mailing Address - Country:US
Mailing Address - Phone:973-546-6161
Mailing Address - Fax:973-546-1708
Practice Address - Street 1:1187 MAIN AVE
Practice Address - Street 2:STE. 1F
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-2252
Practice Address - Country:US
Practice Address - Phone:973-546-6161
Practice Address - Fax:973-546-1708
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02610200207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2906503Medicaid
NJD96550Medicare UPIN
NJ2906503Medicaid