MEDICARE: ANDREW MONTOYA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	085.012161	IL

General Provider Information

NPI Number	:	1205784014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW MONTOYA

Provider Business Mailing Address
First Line	:	146 N MYRTLE AVE
Second Line	:
City	:	VILLA PARK
State	:	IL
Zip	:	60181-2225
Country	:	US
Telephone Number	:	630-484-3696
Fax Number	:

Provider Business Practice Location Address
First Line	:	5741 W CERMAK RD
Second Line	:
City	:	CICERO
State	:	IL
Zip	:	60804-2129
Country	:	US
Telephone Number	:	708-222-0100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2026
Last Update Date	:	03/18/2026

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Directions to “ ANDREW MONTOYA ” Practice Location

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