Provider Demographics
NPI:1104905009
Name:MUNOZ, DAVID (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:MUNOZ
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 1:3611 S CHICAGO AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SOUTH MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53172
Mailing Address - Country:US
Mailing Address - Phone:414-762-7270
Mailing Address - Fax:414-762-4225
Practice Address - Street 1:3611 S. CHICAGO AVE
Practice Address - Street 2:STE 100
Practice Address - City:SOUTH MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53172-3738
Practice Address - Country:US
Practice Address - Phone:414-762-7270
Practice Address - Fax:414-762-7864
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI34253207QG0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI68015-0129Medicare PIN
WI02120-0015Medicare PIN