=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376631895
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EDUARDO MONTILLA MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1435 W 49TH PLACE #201
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33012-3192
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-282-4155
-----------------------------------------------------
Fax | 305-261-0603
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1435 W 49TH PLACE #201
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33012-3192
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-282-4155
-----------------------------------------------------
Fax | 305-261-0603
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | ME22275
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------