Healthcare Provider Details

I. General information

NPI: 1164472692
Provider Name (Legal Business Name): MARK A MONTE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 E 1ST ST STE P302
DULUTH MN
55805-2201
US

IV. Provider business mailing address

920 E 1ST ST STE P302
DULUTH MN
55805-2201
US

V. Phone/Fax

Practice location:
  • Phone: 218-249-6050
  • Fax:
Mailing address:
  • Phone: 218-249-6050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number40076
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: