Provider Demographics
NPI:1790307585
Name:MONTAGNER ROSSI, RAQUEL (MD)
Entity Type:Individual
Prefix:MS
First Name:RAQUEL
Middle Name:
Last Name:MONTAGNER ROSSI
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 1:1350 W. BETHUNE ST. APT 1809
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2608
Mailing Address - Country:US
Mailing Address - Phone:313-598-8854
Mailing Address - Fax:
Practice Address - Street 1:2799 W. GRAND BOULVARD
Practice Address - Street 2:HENRY FORD HOSPITAL, MEDICAL EDUCATION DEPARTMENT
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2608
Practice Address - Country:US
Practice Address - Phone:313-916-8445
Practice Address - Fax:313-916-9434
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-14
Last Update Date:2022-02-23
Deactivation Date:2022-01-17
Deactivation Code:
Reactivation Date:2022-02-23
Provider Licenses
StateLicense IDTaxonomies
MI4351046146207L00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology