Healthcare Provider Details

I. General information

NPI: 1669554663
Provider Name (Legal Business Name): FRANKLIN DEL ROSARIO MONTELLANO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 03/15/2024
Certification Date: 03/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 RANDALL RD PATHOLOGY DEPT
GENEVA IL
60134-4200
US

IV. Provider business mailing address

PO BOX 1048 DEPT 1000
ST CHARLES IL
60174-7048
US

V. Phone/Fax

Practice location:
  • Phone: 630-232-8322
  • Fax:
Mailing address:
  • Phone: 847-495-1617
  • Fax: 847-538-4866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberU8487
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number036089636
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: