Provider Demographics
NPI:1669678272
Name:MONTALVO, ABELARDO
Entity Type:Individual
Prefix:DR
First Name:ABELARDO
Middle Name:
Last Name:MONTALVO
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:ABELARDO
Other - Middle Name:
Other - Last Name:MONTALVO ROMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5112 SW 163RD CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-5097
Mailing Address - Country:US
Mailing Address - Phone:305-221-6016
Mailing Address - Fax:305-207-2196
Practice Address - Street 1:18201 SW 12TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33194-2700
Practice Address - Country:US
Practice Address - Phone:305-207-2135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10268207Q00000X
MI4301081207207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR8-3651Medicare ID - Type Unspecified
PRF73472Medicare UPIN