Healthcare Provider Details

I. General information

NPI: 1164625760
Provider Name (Legal Business Name): PETER P. MONTELEONE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2007
Last Update Date: 11/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 SETON PKWY SUITE 450
KYLE TX
78640-6178
US

IV. Provider business mailing address

1301 W 38TH ST SUITE 400
AUSTIN TX
78705-1000
US

V. Phone/Fax

Practice location:
  • Phone: 512-504-0860
  • Fax: 512-504-0861
Mailing address:
  • Phone: 512-324-3440
  • Fax: 512-406-6513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberQ8962
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberQ8962
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: