Provider Demographics
NPI:1124092804
Name:MUNOZ, PHILLIP A (MD)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:A
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 1:14275 MIDWAY RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3614
Mailing Address - Country:US
Mailing Address - Phone:214-932-8029
Mailing Address - Fax:610-271-4245
Practice Address - Street 1:10330 HICKMAN MILLS DR
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64137-1618
Practice Address - Country:US
Practice Address - Phone:816-412-7004
Practice Address - Fax:816-763-7536
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-19124207ZP0101X
MOR2J39207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO662000006OtherMEDICARE PTAN
MO1124092804Medicaid
KS662A00007OtherMEDICARE PTAN
MOR2J39OtherMO LICENSE
KS100124790FMedicaid
KS04-19124OtherKANSAS LICENSE
KS100124790FMedicaid