Provider Demographics
NPI:1528145497
Name:MONTANTE, RAUL MALLARE (MD)
Entity type:Individual
Prefix:DR
First Name:RAUL
Middle Name:MALLARE
Last Name:MONTANTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:48760 N TERRITORIAL RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-2849
Mailing Address - Country:US
Mailing Address - Phone:734-927-4414
Mailing Address - Fax:
Practice Address - Street 1:25711 W WARREN ST
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-2046
Practice Address - Country:US
Practice Address - Phone:313-274-2400
Practice Address - Fax:313-274-6459
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301061984207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine