Basic Information
| Provider Information | |||||||||
| NPI: | 1518997873 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MUNK | ||||||||
| FirstName: | CHRISTIAN | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 511 TRENIER DR | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890029730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022080866 | ||||||||
| FaxNumber: | 7024202534 | ||||||||
| Practice Location | |||||||||
| Address1: | 1510 W HORIZON RIDGE PKWY STE 140 | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890123502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028780070 | ||||||||
| FaxNumber: | 7028181928 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2006 | ||||||||
| LastUpdateDate: | 12/29/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 229045 | MA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 4572 | AZ | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | DO1372 | NV | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 1518997873 | 05 | NV | MEDICAID |