Provider Demographics
NPI:1689623761
Name:MUNIAK, DANIEL ANTHONY (PA)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:ANTHONY
Last Name:MUNIAK
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 MARGUERITE AVE
Mailing Address - Street 2:
Mailing Address - City:JORDAN
Mailing Address - State:MT
Mailing Address - Zip Code:59337
Mailing Address - Country:US
Mailing Address - Phone:406-557-2819
Mailing Address - Fax:
Practice Address - Street 1:LEAVITT AVE
Practice Address - Street 2:
Practice Address - City:JORDAN
Practice Address - State:MT
Practice Address - Zip Code:59337
Practice Address - Country:US
Practice Address - Phone:406-557-2499
Practice Address - Fax:406-557-2950
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT25363A00000X
WY359363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTR10510Medicare UPIN