Healthcare Provider Details

I. General information

NPI: 1851978092
Provider Name (Legal Business Name): MATTHEW JOSEPH MONTANARELLA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3990 JOHN R ST
DETROIT MI
48201-2018
US

IV. Provider business mailing address

PO BOX 18998
BELFAST ME
04915-4084
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-5111
  • Fax: 313-745-3500
Mailing address:
  • Phone: 469-803-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number5101027811
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: