Provider Demographics
NPI:1881699858
Name:MUNIM, AMJAD (MD)
Entity type:Individual
Prefix:DR
First Name:AMJAD
Middle Name:
Last Name:MUNIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11527
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33339
Mailing Address - Country:US
Mailing Address - Phone:954-771-7900
Mailing Address - Fax:954-771-6863
Practice Address - Street 1:1820 E COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-3725
Practice Address - Country:US
Practice Address - Phone:954-771-7900
Practice Address - Fax:954-771-6863
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME39847174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL043964900Medicaid
FLME39847OtherSTATE LICENSE
FL94415Medicare ID - Type Unspecified
FL043964900Medicaid