Healthcare Provider Details

I. General information

NPI: 1013283779
Provider Name (Legal Business Name): DANIEL ENRIQUE MONTENEGRO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 NE 164TH ST STE 200
NORTH MIAMI BEACH FL
33162-4018
US

IV. Provider business mailing address

1701 NE 164TH ST STE 200
NORTH MIAMI BEACH FL
33162-4018
US

V. Phone/Fax

Practice location:
  • Phone: 305-947-0027
  • Fax: 305-945-8734
Mailing address:
  • Phone: 305-947-0027
  • Fax: 305-945-8734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME142618
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: