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NPI Code Detail

MEDICARE: RICHARD MONTES PA-C

MEDICARE: RICHARD MONTES PA-C
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
1363A00000XPhysician Assistant085.003816IL

General Provider Information

NPI Number : 1588978019
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD MONTES PA-C
Provider Business Mailing Address
First Line : 3153 W FULLERTON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60647-2809
Country : US
Telephone Number : 773-395-4600
Fax Number : 773-395-4633
Provider Business Practice Location Address
First Line : 3153 W FULLERTON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60647-2809
Country : US
Telephone Number : 773-395-4600
Fax Number : 773-395-4633
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2010
Last Update Date : 07/18/2016

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Directions to “ RICHARD MONTES PA-C” Practice Location

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