Provider Demographics
NPI:1578841177
Name:MUNOZ MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:MUNOZ MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNOZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-450-1952
Mailing Address - Street 1:5129 N AUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-1902
Mailing Address - Country:US
Mailing Address - Phone:773-450-1952
Mailing Address - Fax:708-447-3022
Practice Address - Street 1:5129 N AUSTIN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-1902
Practice Address - Country:US
Practice Address - Phone:773-450-1952
Practice Address - Fax:708-447-3022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-30
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036119790261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care