Provider Demographics
NPI:1194927293
Name:MONFORTE, SUMMER ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:SUMMER
Middle Name:ELIZABETH
Last Name:MONFORTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUMMER
Other - Middle Name:ELIZABETH
Other - Last Name:NAMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19 FALCON HEIGHTS DRIVE
Mailing Address - Street 2:
Mailing Address - City:CLANCY
Mailing Address - State:MT
Mailing Address - Zip Code:59634
Mailing Address - Country:US
Mailing Address - Phone:406-457-4180
Mailing Address - Fax:
Practice Address - Street 1:121 N. LAST CHANCE GULCH, LOGAN HEALTH CHILDREN'S SPECI
Practice Address - Street 2:SUITE C
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601
Practice Address - Country:US
Practice Address - Phone:406-603-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT18722207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO48980820Medicaid
COFM2191601OtherDEA
COCOAAA0608Medicare PIN