Provider Demographics
NPI:1275829954
Name:MONTOYA, RAYMOND R II (DPM)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:R
Last Name:MONTOYA
Suffix:II
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 1:259 E ERIE ST STE 2230
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3370
Mailing Address - Country:US
Mailing Address - Phone:312-926-6000
Mailing Address - Fax:312-926-8267
Practice Address - Street 1:259 E ERIE ST STE 2230
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3370
Practice Address - Country:US
Practice Address - Phone:312-926-6000
Practice Address - Fax:312-926-8267
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005559213ES0103X, 213E00000X
IL135000730207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL364322013Medicaid