Provider Demographics
NPI:1578634226
Name:MUNFAKH, NABIL A (MD)
Entity Type:Individual
Prefix:DR
First Name:NABIL
Middle Name:A
Last Name:MUNFAKH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-355-3003
Mailing Address - Fax:314-747-0917
Practice Address - Street 1:11155 DUNN RD
Practice Address - Street 2:DIV SURG CT ADULT-CARDIO, STE 209E
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-6150
Practice Address - Country:US
Practice Address - Phone:314-355-3003
Practice Address - Fax:314-747-0917
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001013803208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205352305Medicaid
ILENROLLEDMedicaid
MO330005639Medicare PIN
ILK22920Medicare PIN
MO003013744Medicare PIN
MO042010412Medicaid
IL$$$$$$$$$Medicaid