Provider Demographics
NPI:1295836005
Name:MONTESANO, JESUS (MD)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:
Last Name:MONTESANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:664 EAST 25TH STREET
Mailing Address - Street 2:SUITE # 101
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-3815
Mailing Address - Country:US
Mailing Address - Phone:305-835-7625
Mailing Address - Fax:305-835-0550
Practice Address - Street 1:664 EAST 25TH STREET
Practice Address - Street 2:SUITE # 101
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013
Practice Address - Country:US
Practice Address - Phone:305-835-7625
Practice Address - Fax:305-835-0550
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0057047207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11694Medicare ID - Type Unspecified
E70188Medicare UPIN