Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 34253 | WI |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 34253 | WI |
NPI | 1104905009 |
---|---|
Provider Name | David Munoz |
First Address | South Milwaukee, WI 53172 |
Second Address | South Milwaukee, WI 53172-3738 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2006 |
Last Update Date | 24/11/2021 |