Provider Demographics
NPI:1659136752
Name:MUNOZ, JESUS MOISES (PA-C)
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:MOISES
Last Name:MUNOZ
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:MR
Other - First Name:JESUS
Other - Middle Name:MOISES
Other - Last Name:MUNOZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:3500 FRANCISCAN WAY
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-0021
Practice Address - Country:US
Practice Address - Phone:219-852-1524
Practice Address - Fax:219-933-2288
Is Sole Proprietor?:No
Enumeration Date:2024-02-19
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10004675A363A00000X, 208M00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant