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General NPI Number Information
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NPI Number | 1205784014
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Entity Type | Individual
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Provider Name | ANDREW MONTOYA
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Gender | Male
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Dates
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Enumeration Date | 03/18/2026
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Last Update Date | 03/18/2026
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Provider Practice Location Address
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Address Line | 5741 W CERMAK RD
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City | CICERO
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State | IL
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Zip | 60804-2129
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Country | US
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Telephone | 708-222-0100
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Fax |
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Provider Business Mailing Address
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Address Line | 146 N MYRTLE AVE
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City | VILLA PARK
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State | IL
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Zip | 60181-2225
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Country | US
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Telephone | 630-484-3696
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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 | 085.012161
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License Number State | IL
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