Healthcare Provider Details

I. General information

NPI: 1811085053
Provider Name (Legal Business Name): FAYE S MONTES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FAYE PB MONTES MD

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 TOWER CT SUITE 150
GURNEE IL
60031
US

IV. Provider business mailing address

15 TOWER CT SUITE 150
GURNEE IL
60031
US

V. Phone/Fax

Practice location:
  • Phone: 847-623-4464
  • Fax: 847-623-9984
Mailing address:
  • Phone: 847-623-4464
  • Fax: 847-623-9984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036096532
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: