Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 37915 | WI |
N | 111NI0900X | Internist | 37915 | WI |
Y | 207RA0401X | Internist - Addiction Medicine | 37915 | WI |
NPI | 1326048976 |
---|---|
Provider Name | Masroor Munim |
First Address | West Allis, WI 53214-4710 |
Second Address | West Allis, WI 53214-4710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2005 |
Last Update Date | 18/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110237343 | RAILROAD MEDICARE (01) | WI |
32248500 | (05) | WI |
G73295 | (02) |