Healthcare Provider Details

I. General information

NPI: 1992187173
Provider Name (Legal Business Name): LUKE ADAM MONTEAGUDO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2015
Last Update Date: 05/21/2020
Certification Date: 05/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 RIVERSIDE AVE
MINNEAPOLIS MN
55454-1450
US

IV. Provider business mailing address

400 STINSON BLVD FL 2
MINNEAPOLIS MN
55413-2614
US

V. Phone/Fax

Practice location:
  • Phone: 612-672-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number66393
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: