Provider Demographics
NPI:1689728602
Name:MASROOR MUNIM MD
Entity Type:Organization
Organization Name:MASROOR MUNIM MD
Other - Org Name:INTERNAL MEDICINE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:MASROOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-543-1441
Mailing Address - Street 1:2400 S 90TH ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2417
Mailing Address - Country:US
Mailing Address - Phone:414-543-1441
Mailing Address - Fax:414-543-1521
Practice Address - Street 1:7200 W GREENFIELD AVENUE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214
Practice Address - Country:US
Practice Address - Phone:414-543-1441
Practice Address - Fax:414-543-1521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty