Provider Demographics
NPI:1194798439
Name:MONTANE, ISMAEL (MD)
Entity type:Individual
Prefix:
First Name:ISMAEL
Middle Name:
Last Name:MONTANE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8940 N KENDALL DR
Mailing Address - Street 2:SUITE #706E
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2148
Mailing Address - Country:US
Mailing Address - Phone:305-595-8600
Mailing Address - Fax:786-497-2664
Practice Address - Street 1:8940 N KENDALL DR
Practice Address - Street 2:SUITE #706E
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2148
Practice Address - Country:US
Practice Address - Phone:305-595-8600
Practice Address - Fax:786-497-2664
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0042372174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL044245300Medicaid
FL96945Medicare ID - Type Unspecified
FL044245300Medicaid