Individual
DR. LAURA E MUNKEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2120 RIETH BLVD, SUITE A, GOSHEN, IN 46526-5843
(574) 875-5126
(574) 875-1874
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01055084A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000200984
ANTHEM BCBS
IN
05
—
200348260
—
IN
01
—
P01316631
RR MEDICARE
IN
Enumeration date
07/20/2005
Last updated
03/31/2021
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