Individual
JAVIER MUNIZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
315 S 13TH ST, STE 2, HERRIN, IL 62948-3619
(618) 942-5883
(618) 942-5921
Mailing address
315 S 13TH ST, STE 2, HERRIN, IL 62948-3619
(618) 942-5883
(618) 942-5921
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036097846
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010143600
BLACK LUNG
—
01
—
10032009
BCBS
IL
01
—
110245013
RR MEDICARE
—
01
—
385740
HEALTHLINK
IL
01
—
39692
HEALTH ALLIANCE
IL
Enumeration date
05/23/2005
Last updated
07/11/2012
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