Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 01050984A | IN |
NPI | 1073515086 |
---|---|
Provider Name | Irfan Munir |
First Address | Oak Brook, IL 60523-1563 |
Second Address | Fort Wayne, IN 46845-1730 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2005 |
Last Update Date | 12/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000095600 | BCBS (01) | IN |
200346200C | (05) | IN |
2187815 | (05) | OH |
G16969 | (02) | IN |