Healthcare Provider Details

I. General information

NPI: 1225346802
Provider Name (Legal Business Name): LUIS CLEMENTE ARCAY MONTAGNE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2010
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 S CONGRESS AVE STE 102
ATLANTIS FL
33462-6636
US

IV. Provider business mailing address

7593 W BOYNTON BEACH BLVD STE 220
BOYNTON BEACH FL
33437-6162
US

V. Phone/Fax

Practice location:
  • Phone: 561-967-5033
  • Fax:
Mailing address:
  • Phone: 561-649-7000
  • Fax: 561-964-4603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2014029653
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME167310
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number15389
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: