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1982650883

NPI Code Detail

MEDICARE: DR. THERESA E MONTOYA-HOUSER MD

MEDICARE: DR. THERESA E MONTOYA-HOUSER 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	207R00000X	Internal Medicine Physician	200101375	NC
2	207R00000X	Internal Medicine Physician	036117394	IL
3	207R00000X	Internal Medicine Physician	65030	GA
4	207QA0505X	Adult Medicine Physician	036117394	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12922	OTHER	NC	BCBS OF NC

General Provider Information

NPI Number	:	1982650883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THERESA E MONTOYA-HOUSER MD

Provider Business Mailing Address
First Line	:	611 W PARK ST
Second Line	:
City	:	URBANA
State	:	IL
Zip	:	61801-2529
Country	:	US
Telephone Number	:	217-383-6941
Fax Number	:

Provider Business Practice Location Address
First Line	:	1818 E WINDSOR RD
Second Line	:
City	:	URBANA
State	:	IL
Zip	:	61802-9566
Country	:	US
Telephone Number	:	217-255-9646
Fax Number	:	217-326-1777

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

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	07/21/2022

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Directions to “ DR. THERESA E MONTOYA-HOUSER MD” Practice Location

Language	Start Address	Practice Location

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