Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 21-2071 | IL |
N | 1223G0001X | General Practice | 19-025634 | IL |
N | 213EG0000X | General Practice | 19-025634 | IL |
NPI | 1164482741 |
---|---|
Provider Name | Dr. Richard Alex Munaretto |
First Address | River Forest, IL 60305-1133 |
Second Address | River Forest, IL 60305-1133 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2006 |
Last Update Date | 02/11/2016 |