Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 036167 | IA |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 36167 | IA |
NPI | 1235113234 |
---|---|
Provider Name | Sandeep Munjal |
First Address | Cedar Rapids, IA 52406-3178 |
Second Address | Cedar Rapids, IA 52403-2404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2005 |
Last Update Date | 21/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0464032 | (05) | IA |
39228 | BLUE CROSS BLUE SHIELD (01) | IA |
I31066 | (02) | IA |