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General NPI Number Information
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NPI Number | 1144819285
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Entity Type | Individual
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Provider Name | LESTER STEPHEN MONTESA PA-C
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Gender | Male
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Dates
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Enumeration Date | 01/13/2021
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Last Update Date | 01/13/2021
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Provider Practice Location Address
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Address Line | 180 N MICHIGAN AVE STE 1605
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City | CHICAGO
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State | IL
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Zip | 60601-7478
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Country | US
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Telephone | 312-201-1234
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Fax |
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Provider Business Mailing Address
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Address Line | 2220 W MAYPOLE AVE UNIT 302
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City | CHICAGO
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State | IL
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Zip | 60612-2342
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Country | US
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Telephone | 510-340-6594
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085.008129
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License Number State | IL
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