Healthcare Provider Details

I. General information

NPI: 1437104544
Provider Name (Legal Business Name): MICHELLE MARIE MONTALBANO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE MARIE MONTALBANO M.D.

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7125 S BRADEN AVE
TULSA OK
74136-6302
US

IV. Provider business mailing address

7125 S BRADEN AVE
TULSA OK
74136-6302
US

V. Phone/Fax

Practice location:
  • Phone: 918-481-8100
  • Fax: 918-481-8128
Mailing address:
  • Phone: 918-481-8100
  • Fax: 918-481-8128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD00045790
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMD00045790
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: