Provider Demographics
NPI:1417904491
Name:MONTEMURRO, ANGELINA M (MD)
Entity Type:Individual
Prefix:
First Name:ANGELINA
Middle Name:M
Last Name:MONTEMURRO
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 1:9555 76TH ST
Mailing Address - Street 2:SUITE 2602
Mailing Address - City:PLEASANT PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53158-1984
Mailing Address - Country:US
Mailing Address - Phone:262-577-8400
Mailing Address - Fax:262-577-8476
Practice Address - Street 1:9555 76TH ST
Practice Address - Street 2:SUITE 2602
Practice Address - City:PLEASANT PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53158-1984
Practice Address - Country:US
Practice Address - Phone:262-577-8400
Practice Address - Fax:262-577-8476
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI27740207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31388100Medicaid
389706828E05OtherANTHEM
WI00663250Medicare PIN
WI31388100Medicaid