Provider Demographics
NPI:1992971550
Name:FONT-MONTGOMERY, ESPERANZA ENID (MD)
Entity type:Individual
Prefix:MRS
First Name:ESPERANZA
Middle Name:ENID
Last Name:FONT-MONTGOMERY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ESPERANZA
Other - Middle Name:ENID
Other - Last Name:FONT CARO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3901 BEAUBIEN ST
Mailing Address - Street 2:SUITE H
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201
Mailing Address - Country:US
Mailing Address - Phone:313-832-9330
Mailing Address - Fax:313-993-8685
Practice Address - Street 1:3950 BEAUBIEN BOULEVARD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-745-5870
Practice Address - Fax:313-993-0390
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301048557208000000X, 207SG0202X
WI52186208000000X
IN01044570208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207SG0202XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Biochemical Genetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1992971550Medicaid
WI1992971550Medicaid
WI736011231Medicare PIN
WI320640131Medicare PIN