Provider Demographics
NPI:1063669752
Name:MONGE, MICHAEL C (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:C
Last Name:MONGE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:225 E CHICAGO AVE # 22
Mailing Address - Street 2:CARDIOVASCULAR SURGERY
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2991
Mailing Address - Country:US
Mailing Address - Phone:312-227-4240
Mailing Address - Fax:312-227-9643
Practice Address - Street 1:225 E CHICAGO AVE # 22
Practice Address - Street 2:CARDIOVASCULAR SURGERY
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2991
Practice Address - Country:US
Practice Address - Phone:312-227-4240
Practice Address - Fax:312-227-9643
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-25
Last Update Date:2020-06-08
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Provider Licenses
StateLicense IDTaxonomies
IL036129140208G00000X
IL36-129140208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036129140OtherSTATE LICENSE