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NPI Code Detail

MEDICARE: MICHAEL PATRICK MONTICO MD

MEDICARE:   MICHAEL PATRICK MONTICO  MD
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
1207Q00000XFamily Medicine Physician4301072084MI
2207QS0010XSports Medicine (Family Medicine) Physician4301072084MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1346249919
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL PATRICK MONTICO MD
Provider Business Mailing Address
First Line : 1050 CORPORATE OFFICE DR STE 100
Second Line :
City : MILFORD
State : MI
Zip : 48381-3199
Country : US
Telephone Number : 248-684-6155
Fax Number : 248-684-6154
Provider Business Practice Location Address
First Line : 1050 CORPORATE OFFICE DR STE 100
Second Line :
City : MILFORD
State : MI
Zip : 48381-3199
Country : US
Telephone Number : 248-684-6155
Fax Number : 248-684-6154
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2005
Last Update Date : 05/20/2021

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Directions to “ MICHAEL PATRICK MONTICO MD” Practice Location

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