Active NPI
Ian W Munger, IDHS
- Independent Duty Medical Technicians
- Selfridge, MI
National Provider Identifier
1407710759
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Independent Duty Medical Technicians
- Practice address
- 43401 N Jefferson Ave
Selfridge, MI 48045-5266 - Phone
- (586) 239-4971
- NPI assigned
- Dec 11, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Independent Duty Medical Technicians | 1710I1003X | Primary |
Addresses
Primary practice location
43401 N Jefferson Ave
Selfridge, MI 48045-5266
Mailing address
1837 W State Blvd
Fort Wayne, IN 46808-1933
Phone (419) 670-4790
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1765411200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1765411200000",
"number": "1407710759",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1837 W STATE BLVD",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468081933",
"telephone_number": "419-670-4790"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "43401 N JEFFERSON AVE",
"city": "SELFRIDGE",
"state": "MI",
"postal_code": "480455266",
"telephone_number": "586-239-4971"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MUNGER",
"first_name": "IAN",
"middle_name": "W",
"credential": "IDHS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-12-11",
"last_updated": "2025-12-11",
"certification_date": "2025-12-11",
"status": "A"
},
"taxonomies": [
{
"code": "1710I1003X",
"taxonomy_group": "",
"desc": "Military Health Care Provider, Independent Duty Medical Technicians",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Selfridge, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.