Provider Demographics
NPI:1912907627
Name:MUNK, RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:MUNK
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 1:2121 HUGHES DR
Mailing Address - Street 2:SUITE 980
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3845
Mailing Address - Country:US
Mailing Address - Phone:419-291-2345
Mailing Address - Fax:419-291-2249
Practice Address - Street 1:2121 HUGHES DR
Practice Address - Street 2:SUITE 980
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3845
Practice Address - Country:US
Practice Address - Phone:419-291-2345
Practice Address - Fax:419-291-2249
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35051137207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH00162OtherPARAMOUNT
OH000000251216OtherANTHEM
OH0576676Medicaid
OH09-00989OtherUHC
MI4499317Medicaid
OH4222095OtherAETNA
OH00162OtherPARAMOUNT
OH09-00989OtherUHC