Provider Demographics
NPI:1497754691
Name:MUNHALL, MICHAEL HOWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:HOWARD
Last Name:MUNHALL
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 1:450 LAUREL ST
Mailing Address - Street 2:STE A
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314-3045
Mailing Address - Country:US
Mailing Address - Phone:515-247-8400
Mailing Address - Fax:515-248-8888
Practice Address - Street 1:450 LAUREL ST
Practice Address - Street 2:STE A
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-3045
Practice Address - Country:US
Practice Address - Phone:515-247-8400
Practice Address - Fax:515-248-8888
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-25037208100000X
IA39090208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100162490BMedicaid
KS101755OtherBLUE CROSS
IA1497754691Medicaid
KS110735Medicare ID - Type Unspecified
IA1497754691Medicaid