Provider Demographics
NPI:1003084286
Name:CORDOBA MUNOZ, MARCOS ITAMAR (MD)
Entity type:Individual
Prefix:DR
First Name:MARCOS
Middle Name:ITAMAR
Last Name:CORDOBA MUNOZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MARCOS
Other - Middle Name:ITAMAR
Other - Last Name:MUNOZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:100 MICHIGAN ST NE # MC845
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25 MICHIGAN ST NE
Practice Address - Street 2:MATERNAL FETAL MEDICINE DEPT
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2515
Practice Address - Country:US
Practice Address - Phone:616-391-3681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036135913207VM0101X, 207VM0101X
MI4301090455207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine