Provider Demographics
NPI:1003875832
Name:MONTUFAR, HENGELBERTH D (DPM)
Entity Type:Individual
Prefix:DR
First Name:HENGELBERTH
Middle Name:D
Last Name:MONTUFAR
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 1:36640 HERITAGE DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:MI
Mailing Address - Zip Code:48062-1937
Mailing Address - Country:US
Mailing Address - Phone:586-727-7867
Mailing Address - Fax:586-727-5598
Practice Address - Street 1:36640 HERITAGE DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:MI
Practice Address - Zip Code:48062-1937
Practice Address - Country:US
Practice Address - Phone:586-727-7867
Practice Address - Fax:586-727-5598
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIHM002127213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4824819Medicaid
MIV06361Medicare UPIN
MI0Q37610Medicare PIN