Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 036117017 | IL |
Y | 207RI0011X | Interventional Cardiology | 036-117017 | IL |
NPI | 1023113743 |
---|---|
Provider Name | Dr. Sudhir Mungee |
First Address | Peoria, IL 61614 |
Second Address | Peoria, IL 61614 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2006 |
Last Update Date | 02/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036117017 | (05) | IL |
036-117017 | (05) | IL |
G53605 | (02) | IL |