Provider Demographics
NPI:1114953205
Name:MONTAG, LORIE A (MD)
Entity Type:Individual
Prefix:DR
First Name:LORIE
Middle Name:A
Last Name:MONTAG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 744327
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-4327
Mailing Address - Country:US
Mailing Address - Phone:515-241-8861
Mailing Address - Fax:515-241-8855
Practice Address - Street 1:1212 PLEASANT
Practice Address - Street 2:SUITE #LL3
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1414
Practice Address - Country:US
Practice Address - Phone:515-241-8861
Practice Address - Fax:515-241-8855
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO102401207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
10001057500OtherCOMMUNITY HEALTH PLAN
25321019OtherBLUE CROSS BLUE SHIELD KC
KS100324250AMedicaid
MO203860804Medicaid
10001057500OtherCOMMUNITY HEALTH PLAN
6658581AMedicare ID - Type Unspecified
MO203860804Medicaid