Provider Demographics
NPI:1861491318
Name:MUNGCAL, NOEL R (MD)
Entity Type:Individual
Prefix:
First Name:NOEL
Middle Name:R
Last Name:MUNGCAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 N MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47240-1487
Mailing Address - Country:US
Mailing Address - Phone:812-663-7277
Mailing Address - Fax:812-662-7307
Practice Address - Street 1:955 N MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:IN
Practice Address - Zip Code:47240-1487
Practice Address - Country:US
Practice Address - Phone:812-663-7277
Practice Address - Fax:812-662-7307
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01043014A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200125450AMedicaid
IN180890LMedicare ID - Type Unspecified
IN200125450AMedicaid