Healthcare Provider Details

I. General information

NPI: 1942232129
Provider Name (Legal Business Name): MONTE LANCE HARVILL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 05/25/2022
Certification Date: 05/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3990 JOHN R ST DEPT OF
DETROIT MI
48201-2018
US

IV. Provider business mailing address

30450 STONEGATE DR
FRANKLIN MI
48025-1401
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-2708
  • Fax:
Mailing address:
  • Phone: 248-910-6023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number4301059831
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301059831
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number4301059831
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: