Healthcare Provider Details

I. General information

NPI: 1124965140
Provider Name (Legal Business Name): MONTREAL MILLER APSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6737 W WASHINGTON ST STE 2275
WEST ALLIS WI
53214-5666
US

IV. Provider business mailing address

4028 N 72ND ST
MILWAUKEE WI
53216-1034
US

V. Phone/Fax

Practice location:
  • Phone: 262-389-2664
  • Fax:
Mailing address:
  • Phone: 262-389-2664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number128479121
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: