MEDICARE: DR. RAUL MALLARE MONTANTE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	4301061984	MI

General Provider Information

NPI Number	:	1528145497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAUL MALLARE MONTANTE M.D.

Provider Business Mailing Address
First Line	:	48760 N TERRITORIAL RD
Second Line	:
City	:	PLYMOUTH
State	:	MI
Zip	:	48170-2849
Country	:	US
Telephone Number	:	734-927-4414
Fax Number	:

Provider Business Practice Location Address
First Line	:	25711 W WARREN ST
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-2046
Country	:	US
Telephone Number	:	313-274-2400
Fax Number	:	313-274-6459

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	07/08/2007

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