Provider Demographics
NPI:1407195639
Name:MONTEZ, MANUEL RAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:RAUL
Last Name:MONTEZ
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 1:1261 OAK KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-3665
Mailing Address - Country:US
Mailing Address - Phone:847-337-4752
Mailing Address - Fax:
Practice Address - Street 1:1261 OAK KNOLL DR
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-3665
Practice Address - Country:US
Practice Address - Phone:847-337-4752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036115314207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology