Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | DS-024081-L | PA |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DS024081L | PA |
NPI | 1245252659 |
---|---|
Provider Name | Dr. Michael J. Mundenar |
First Address | Yardley, PA 19067-5528 |
Second Address | Yardley, PA 19067-5528 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 22/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00042493000 | KEYSTONE HEALTH PLAN EAST (01) | PA |
166433 | HIGHMARK/BLUE SHIELD (01) | PA |
68626 | AETNA ID # (01) | PA |
U09178 | (02) | PA |
WA190229655 | MEDICARE RR # (01) | PA |