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General NPI Number Information
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NPI Number | 1659545713
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Entity Type | Individual
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Provider Name | MICHAEL EDWARD MONTEJO M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/18/2008
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Last Update Date | 04/25/2012
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Provider Practice Location Address
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Address Line | 2501 N ORANGE AVE SUITE 181
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City | ORLANDO
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State | FL
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Zip | 32804-4603
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Country | US
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Telephone | 407-303-2030
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Fax | 407-303-2040
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Provider Business Mailing Address
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Address Line | PO BOX 1031
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City | ORLANDO
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State | FL
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Zip | 32802-1031
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Country | US
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Telephone | 407-872-7786
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Fax | 407-872-3630
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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 | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 6894390-1205
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | ME109892
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License Number State | FL
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