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General NPI Number Information
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NPI Number | 1295895738
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Entity Type | Individual
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Provider Name | TINIKA A MONTGOMERY M.D.
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Gender | Female
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 08/26/2024
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Provider Practice Location Address
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Address Line | 2101 ELM ST N
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City | FARGO
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State | ND
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Zip | 58102-2417
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Country | US
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Telephone | 701-239-3700
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Fax | 701-451-7891
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Provider Business Mailing Address
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Address Line | 2101 ELM ST N
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City | FARGO
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State | ND
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Zip | 58102-2417
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Country | US
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Telephone | 701-239-3700
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Fax | 701-451-7891
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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 | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 312009
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 054523
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 75296
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 0101243122
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License Number State | VA
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