Provider Demographics
NPI:1558525998
Name:MONTAGNESE, MIGUEL D (MD)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:D
Last Name:MONTAGNESE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:400 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-3207
Mailing Address - Country:US
Mailing Address - Phone:330-602-7702
Mailing Address - Fax:330-602-4169
Practice Address - Street 1:400 MEDICAL PARK DR
Practice Address - Street 2:SUITE 203
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-3207
Practice Address - Country:US
Practice Address - Phone:330-602-7702
Practice Address - Fax:330-602-4169
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH091950208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery