Provider Demographics
NPI:1548263668
Name:MUNIZ, JAVIER (DO)
Entity type:Individual
Prefix:
First Name:JAVIER
Middle Name:
Last Name:MUNIZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:315 S 13TH ST
Mailing Address - Street 2:STE 2
Mailing Address - City:HERRIN
Mailing Address - State:IL
Mailing Address - Zip Code:62948-3619
Mailing Address - Country:US
Mailing Address - Phone:618-942-5883
Mailing Address - Fax:618-942-5921
Practice Address - Street 1:315 S 13TH ST
Practice Address - Street 2:STE 2
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948-3619
Practice Address - Country:US
Practice Address - Phone:618-942-5883
Practice Address - Fax:618-942-5921
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036097846207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL10032009OtherBCBS
010143600OtherBLACK LUNG
IL385740OtherHEALTHLINK
IL39692OtherHEALTH ALLIANCE
110245013OtherRR MEDICARE
110245013OtherRR MEDICARE
IL10032009OtherBCBS