Provider Demographics
NPI:1629411129
Name:MUNSHI, JUNAID (MD)
Entity Type:Individual
Prefix:
First Name:JUNAID
Middle Name:
Last Name:MUNSHI
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 1:3844 S LINDBERGH BLVD STE 235
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1369
Mailing Address - Country:US
Mailing Address - Phone:314-525-0560
Mailing Address - Fax:314-525-0565
Practice Address - Street 1:3844 S LINDBERGH BLVD STE 235
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127
Practice Address - Country:US
Practice Address - Phone:314-525-0560
Practice Address - Fax:314-525-0565
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-15
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA302543207Q00000X
390200000X
MO2018011621207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04108724Medicaid
LA2329308Medicaid
MS04108724Medicaid