Provider Demographics
NPI:1669626313
Name:EDUARDO MONTILLA MD PA
Entity Type:Organization
Organization Name:EDUARDO MONTILLA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTILLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-823-2710
Mailing Address - Street 1:1435 W 49TH PLACE SUITE 201
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3192
Mailing Address - Country:US
Mailing Address - Phone:305-823-2710
Mailing Address - Fax:305-826-8531
Practice Address - Street 1:1435 W 49TH PLACE SUITE 201
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3192
Practice Address - Country:US
Practice Address - Phone:305-823-2710
Practice Address - Fax:305-826-8531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-07
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME22875207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD27585Medicare UPIN