Provider Demographics
NPI:1396771309
Name:MUNASIFI, URSULA L (MD)
Entity type:Individual
Prefix:
First Name:URSULA
Middle Name:L
Last Name:MUNASIFI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:URSULA
Other - Middle Name:
Other - Last Name:MARKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:255 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2218
Mailing Address - Country:US
Mailing Address - Phone:517-787-6440
Mailing Address - Fax:517-787-4146
Practice Address - Street 1:744 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1909
Practice Address - Country:US
Practice Address - Phone:517-787-6440
Practice Address - Fax:517-787-4146
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101237446207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology