Provider Demographics
NPI:1235420225
Name:ISMAEL MONTANE MD,PA
Entity Type:Organization
Organization Name:ISMAEL MONTANE MD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ISMAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-595-8600
Mailing Address - Street 1:8940 N KENDALL DR
Mailing Address - Street 2:706E
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2148
Mailing Address - Country:US
Mailing Address - Phone:305-595-8600
Mailing Address - Fax:786-497-2664
Practice Address - Street 1:8940 N KENDALL DR
Practice Address - Street 2:706E
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2148
Practice Address - Country:US
Practice Address - Phone:305-595-8600
Practice Address - Fax:786-497-2664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0042372174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL044245300Medicaid
FL96945Medicare PIN