Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 036135913 | IL |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 4301090455 | MI |
NPI | 1003084286 |
---|---|
Provider Name | Dr. Marcos Itamar Cordoba Munoz |
First Address | Grand Rapids, MI 49503-2560 |
Second Address | Grand Rapids, MI 49503-2515 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2008 |
Last Update Date | 05/01/2021 |