Provider Demographics
NPI:1649227216
Name:MUNNICH, JO MARIE ANGELL (MD)
Entity Type:Individual
Prefix:
First Name:JO MARIE
Middle Name:ANGELL
Last Name:MUNNICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:568 5TH AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-3093
Mailing Address - Country:US
Mailing Address - Phone:415-794-4423
Mailing Address - Fax:415-766-4422
Practice Address - Street 1:568 5TH AVE APT 2
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-3093
Practice Address - Country:US
Practice Address - Phone:415-794-4423
Practice Address - Fax:415-766-4422
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA068332207QA0505X
CAA68332207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H06294Medicare UPIN