Provider Demographics
NPI:1386934008
Name:MONTOYA, ERIKA (MD)
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:MONTOYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-1108
Mailing Address - Country:US
Mailing Address - Phone:708-386-0845
Mailing Address - Fax:708-386-8472
Practice Address - Street 1:6201 ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-1108
Practice Address - Country:US
Practice Address - Phone:708-386-0845
Practice Address - Fax:708-386-8472
Is Sole Proprietor?:No
Enumeration Date:2011-04-14
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL036134800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program