Provider Demographics
NPI:1790718815
Name:MUNIR, SYED MUZAFFAR (MD)
Entity Type:Individual
Prefix:
First Name:SYED
Middle Name:MUZAFFAR
Last Name:MUNIR
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:PO BOX 1802
Mailing Address - Street 2:DEPARTMENT OF PSYCHIATRY
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-0180
Mailing Address - Country:US
Mailing Address - Phone:318-813-2445
Mailing Address - Fax:318-813-2447
Practice Address - Street 1:39001 SUNDALE DR
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538
Practice Address - Country:US
Practice Address - Phone:318-426-9228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15074R2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1158968Medicaid
LAG90191Medicare UPIN
LA1158968Medicaid