Provider Demographics
NPI:1265422067
Name:MUNESES, MARLON TAN (MD)
Entity type:Individual
Prefix:MR
First Name:MARLON
Middle Name:TAN
Last Name:MUNESES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:101 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:PANA
Mailing Address - State:IL
Mailing Address - Zip Code:62557-1716
Mailing Address - Country:US
Mailing Address - Phone:217-562-2544
Mailing Address - Fax:217-562-6288
Practice Address - Street 1:101 E 9TH ST
Practice Address - Street 2:
Practice Address - City:PANA
Practice Address - State:IL
Practice Address - Zip Code:62557-1716
Practice Address - Country:US
Practice Address - Phone:217-562-2544
Practice Address - Fax:217-562-6288
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036096593207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
069003OtherHEALTH ALLIANE
384581OtherUNITED MEDICAL RESOURCES
5369708OtherAETNA
109744OtherPERSONAL CARE
080173568OtherRAILROAD MEDICARE
384581OtherHEALTHLINK
IL5827807OtherBLUE CROSS BLUE SHIELD
IL036096593Medicaid
1832428OtherUNITED HEALTHCARE
IL5827807OtherBLUE CROSS BLUE SHIELD
384581OtherUNITED MEDICAL RESOURCES