Healthcare Provider Details

I. General information

NPI: 1962470146
Provider Name (Legal Business Name): CAROL A MONTJOY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 03/19/2021
Certification Date: 03/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 WILSON CREEK RD
LAWRENCEBURG IN
47025-1095
US

IV. Provider business mailing address

PO BOX 635283
CINCINNATI OH
45263-5283
US

V. Phone/Fax

Practice location:
  • Phone: 812-537-8333
  • Fax: 812-537-8334
Mailing address:
  • Phone: 812-537-8333
  • Fax: 812-537-8334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number01057683A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number50905
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number50905
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number01057683A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: