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NPI Code Detail

MEDICARE: DR. ERVY MARIE MONTOYA SA

MEDICARE: DR. ERVY MARIE MONTOYA SA
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
1363AS0400XSurgical Physician Assistant

General Provider Information

NPI Number : 1265067326
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ERVY MARIE MONTOYA SA
Provider Business Mailing Address
First Line : 7157 W HOWARD ST
Second Line :
City : NILES
State : IL
Zip : 60714-3757
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7157 W HOWARD ST
Second Line :
City : NILES
State : IL
Zip : 60714-3757
Country : US
Telephone Number : 847-696-9900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/10/2020
Last Update Date : 03/10/2020

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Directions to “ DR. ERVY MARIE MONTOYA SA” Practice Location

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