Provider Demographics
NPI:1922040542
Name:MUNIYAPPA, PRAVIN KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:PRAVIN
Middle Name:KUMAR
Last Name:MUNIYAPPA
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 1:2525 S MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2315
Mailing Address - Country:US
Mailing Address - Phone:312-945-8640
Mailing Address - Fax:312-626-2170
Practice Address - Street 1:2525 S MICHIGAN AVE
Practice Address - Street 2:2-614
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2315
Practice Address - Country:US
Practice Address - Phone:312-945-8640
Practice Address - Fax:312-626-2170
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036105193207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036105193Medicaid
CA00A782820Medicaid
IL970670004Medicare UPIN
IL036105193Medicaid
CAWA78282Medicare ID - Type Unspecified