Provider Demographics
NPI:1528077526
Name:MONTONI, JOHN (DPM)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:MONTONI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25990 KELLY RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-4483
Mailing Address - Country:US
Mailing Address - Phone:586-771-3550
Mailing Address - Fax:
Practice Address - Street 1:25990 KELLY RD
Practice Address - Street 2:SUITE 4
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-4483
Practice Address - Country:US
Practice Address - Phone:586-771-3550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001697213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3148184Medicaid
MIU56645Medicare UPIN
MIOM58050Medicare ID - Type Unspecified