Provider Demographics
NPI:1700807575
Name:JAVIER MUNIZ, DO, LLC
Entity Type:Organization
Organization Name:JAVIER MUNIZ, DO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNIZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:618-942-5883
Mailing Address - Street 1:315 S 13TH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HERRIN
Mailing Address - State:IL
Mailing Address - Zip Code:62948-3619
Mailing Address - Country:US
Mailing Address - Phone:618-942-5883
Mailing Address - Fax:618-942-5921
Practice Address - Street 1:315 S 13TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948-3619
Practice Address - Country:US
Practice Address - Phone:618-942-5883
Practice Address - Fax:618-942-5921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036097846207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL385740OtherHEALTHLINK
IL39692OtherHEALTH ALLIANCE
IL036097846Medicaid
IL10032009OtherBCBS
IL101436OtherBLACK LUNG
IL110245013OtherRR MEDICARE
IL110245013OtherRR MEDICARE
IL213827Medicare PIN