MEDICARE: MRS. DANIELA ESTHER MONTENEGRO 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
1	207Q00000X	Family Medicine Physician	STUDENT	IL

General Provider Information

NPI Number	:	1972287910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DANIELA ESTHER MONTENEGRO MD

Provider Business Mailing Address
First Line	:	2050 W OGDEN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3737
Country	:	US
Telephone Number	:	202-999-2922
Fax Number	:

Provider Business Practice Location Address
First Line	:	2050 W OGDEN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3737
Country	:	US
Telephone Number	:	202-999-2922
Fax Number	:

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

Provider Enumeration Date	:	06/12/2023
Last Update Date	:	06/12/2023

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