Provider Demographics
NPI:1144665472
Name:MUNOZ, MARTIN ENOC
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:ENOC
Last Name:MUNOZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 REID PKWY
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-966-5527
Mailing Address - Fax:765-966-5528
Practice Address - Street 1:1485 CHESTER BLVD
Practice Address - Street 2:REID PEDIATRIC & INTERNAL MEDICINE
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1919
Practice Address - Country:US
Practice Address - Phone:765-966-5527
Practice Address - Fax:765-966-5528
Is Sole Proprietor?:No
Enumeration Date:2013-04-30
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01076999A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000001018795OtherANTHEM
OH0171434Medicaid
IN201361720Medicaid
IN259370159Medicare PIN