Provider Demographics
NPI:1710928429
Name:FARJO, MUNA K (MD)
Entity Type:Individual
Prefix:DR
First Name:MUNA
Middle Name:K
Last Name:FARJO
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:3001 PLYMOUTH RD
Mailing Address - Street 2:SUITE # 101
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-3205
Mailing Address - Country:US
Mailing Address - Phone:734-668-4700
Mailing Address - Fax:734-747-8995
Practice Address - Street 1:3001 PLYMOUTH RD
Practice Address - Street 2:SUITE # 101
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-3205
Practice Address - Country:US
Practice Address - Phone:734-668-4700
Practice Address - Fax:734-747-8995
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301037565207ZP0102X, 207N00000X, 207ND0900X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2208114661OtherBC/BS
MI690H115140OtherBC/BS
MIP32200001Medicare PIN