Provider Demographics
NPI:1174624779
Name:MUNI, HARESH (MD)
Entity type:Individual
Prefix:
First Name:HARESH
Middle Name:
Last Name:MUNI
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 1:210 S DESPLAINES ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-5500
Mailing Address - Country:US
Mailing Address - Phone:312-654-2700
Mailing Address - Fax:312-654-9930
Practice Address - Street 1:2740 W FOSTER AVE
Practice Address - Street 2:SUITE 211
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3547
Practice Address - Country:US
Practice Address - Phone:773-728-0857
Practice Address - Fax:773-989-2307
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-050212207R00000X
IL036050212207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC41806Medicare UPIN