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General NPI Number Information
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NPI Number | 1043542459
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Entity Type | Organization
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Legal Business Name | ELIEZER MONGE, M.D., P.C.
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Dates
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Enumeration Date | 02/10/2010
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Last Update Date | 01/21/2013
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Provider Practice Location Address
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Address Line | 23607 FARMINGTON RD
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City | FARMINGTON
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State | MI
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Zip | 48336-3109
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Country | US
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Telephone | 248-474-5215
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Fax | 248-474-7260
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Provider Business Mailing Address
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Address Line | 23607 FARMINGTON RD
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City | FARMINGTON
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State | MI
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Zip | 48336-3109
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Country | US
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Telephone | 248-474-5215
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Fax | 248-474-7260
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Authorized Official
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Title or Position | PRESIDENT/PHYSICIAN
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Name | DR. ELIEZER MONGE
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Credential | M.D.
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Telephone | 248-474-5215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 4301027308
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License Number State | MI
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