Basic Information
| Provider Information | |||||||||
| NPI: | 1154658292 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TANEJA | ||||||||
| FirstName: | MUNISH | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2650 RIDGE AVE | ||||||||
| Address2: | |||||||||
| City: | EVANSTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 602011718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475701463 | ||||||||
| FaxNumber: | 8477335768 | ||||||||
| Practice Location | |||||||||
| Address1: | 2650 RIDGE AVE | ||||||||
| Address2: | |||||||||
| City: | EVANSTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 602011718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475701463 | ||||||||
| FaxNumber: | 8477335768 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2009 | ||||||||
| LastUpdateDate: | 05/27/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 28019 | OK | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 036.131832 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0300X | 036.131832 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | 207RG0300X | 28019 | OK | N | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | 208M00000X | 036131832 | IL | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.