Basic Information
| Provider Information | |||||||||
| NPI: | 1417077603 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MUNJAL | ||||||||
| FirstName: | JITENDER | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3709 N CAMPBELL AVE STE 201 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857191563 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208382122 | ||||||||
| FaxNumber: | 5208382245 | ||||||||
| Practice Location | |||||||||
| Address1: | 6565 E CARONDELET DR STE 301 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857102159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208383540 | ||||||||
| FaxNumber: | 5203243526 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2007 | ||||||||
| LastUpdateDate: | 03/11/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0001X | 55207 | AZ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology | 207R00000X | 35088205 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | 35088205 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0001X | 35 088205 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
ID Information
| ID | Type | State | Issuer | Description | 3003636 | 05 | OH | MEDICAID | 332319 | 05 | AZ | MEDICAID |