Provider Demographics
NPI:1073230538
Name:MONTEVIDEO, ANTHONY
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:MONTEVIDEO
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 1:1465 HILLCREST AVE APT 40
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:OH
Mailing Address - Zip Code:44446-3758
Mailing Address - Country:US
Mailing Address - Phone:234-806-6787
Mailing Address - Fax:
Practice Address - Street 1:336 VIENNA AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:OH
Practice Address - Zip Code:44446-2628
Practice Address - Country:US
Practice Address - Phone:234-544-3322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator