Provider Demographics
NPI:1558510172
Name:MATTU, MUNIS A (MD)
Entity Type:Individual
Prefix:
First Name:MUNIS
Middle Name:A
Last Name:MATTU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MUNIS
Other - Middle Name:AZIM
Other - Last Name:MATTU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:901 E 104TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-4517
Mailing Address - Country:US
Mailing Address - Phone:816-502-7000
Mailing Address - Fax:
Practice Address - Street 1:4320 WORNALL RD STE 304
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3206
Practice Address - Country:US
Practice Address - Phone:816-932-2836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-18
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT047408207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology