MEDICARE: DR. MICHAEL MONTOPOLI MD, MPH

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	2083P0500X	Preventive Medicine/Occupational Environmental Medicine Physician		IL

General Provider Information

NPI Number	:	1245236074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL MONTOPOLI MD, MPH

Provider Business Mailing Address
First Line	:	4201 37TH ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20008-3132
Country	:	US
Telephone Number	:	202-966-2642
Fax Number	:

Provider Business Practice Location Address
First Line	:	4201 37TH ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20008-3132
Country	:	US
Telephone Number	:	202-966-2642
Fax Number	:

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

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	07/08/2007

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