Provider Demographics
NPI:1972874295
Name:WILLIAM MONTANO, M.D., INC.
Entity type:Organization
Organization Name:WILLIAM MONTANO, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROXANNE
Authorized Official - Middle Name:NMI
Authorized Official - Last Name:STICKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-452-8151
Mailing Address - Street 1:1919 LATHROP ST STE 204
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-5942
Mailing Address - Country:US
Mailing Address - Phone:907-452-8151
Mailing Address - Fax:907-452-8153
Practice Address - Street 1:1919 LATHROP ST STE 204
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5942
Practice Address - Country:US
Practice Address - Phone:907-452-8151
Practice Address - Fax:907-452-8153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKMD 1335208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD 1335Medicaid
AKC96917Medicare UPIN
AKK000BLBNCMedicare PIN