Healthcare Provider Details

I. General information

NPI: 1285929448
Provider Name (Legal Business Name): ABBY MONTAGUE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ABBY CHRISTENSEN

II. Dates (important events)

Enumeration Date: 06/16/2011
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 CHICAGO AVE
MINNEAPOLIS MN
55404-4518
US

IV. Provider business mailing address

2525 CHICAGO AVE
MINNEAPOLIS MN
55404-4518
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080T0002X
TaxonomyPediatric Medical Toxicology Physician
License Number55959
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number55959
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number55959
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: