Provider Demographics
NPI:1760505887
Name:MONTRICUL, VINAI (MD)
Entity Type:Individual
Prefix:
First Name:VINAI
Middle Name:
Last Name:MONTRICUL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:VINAI
Other - Middle Name:
Other - Last Name:MONTRICUL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:47910 AL HIGHWAY 277
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35740-7206
Mailing Address - Country:US
Mailing Address - Phone:256-495-2131
Mailing Address - Fax:
Practice Address - Street 1:47910 AL HIGHWAY 277
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:AL
Practice Address - Zip Code:35740-7206
Practice Address - Country:US
Practice Address - Phone:256-495-2131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7940207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine