Provider Demographics
NPI:1962969881
Name:MUNRO, MONIQUE (MD)
Entity type:Individual
Prefix:DR
First Name:MONIQUE
Middle Name:
Last Name:MUNRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 WEST TAYLOR STREET
Mailing Address - Street 2:SUITE 3138
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612
Mailing Address - Country:US
Mailing Address - Phone:312-468-6031
Mailing Address - Fax:312-996-7770
Practice Address - Street 1:1855 W TAYLOR STREET. SUITE 3138 ILLINOIS EYE AND INFIR
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-966-6660
Practice Address - Fax:312-996-6572
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-27
Last Update Date:2019-10-23
Deactivation Date:2019-10-09
Deactivation Code:
Reactivation Date:2019-10-22
Provider Licenses
StateLicense IDTaxonomies
ZZ390200000X
IL036.149392207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program