Provider Demographics
NPI:1902648660
Name:MONTONI, ANTONIO ROBERT
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:ROBERT
Last Name:MONTONI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 BERWYN ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-3723
Mailing Address - Country:US
Mailing Address - Phone:313-909-1809
Mailing Address - Fax:
Practice Address - Street 1:605 BERWYN ST
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-3723
Practice Address - Country:US
Practice Address - Phone:313-909-1809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program