Provider Demographics
NPI:1922044791
Name:MONTILUS, MAC ADOLF (MD)
Entity Type:Individual
Prefix:MR
First Name:MAC
Middle Name:ADOLF
Last Name:MONTILUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4314 LUDGATE ST
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2461
Mailing Address - Country:US
Mailing Address - Phone:910-272-8800
Mailing Address - Fax:910-272-0508
Practice Address - Street 1:4314 LUDGATE ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2461
Practice Address - Country:US
Practice Address - Phone:910-272-8800
Practice Address - Fax:910-272-0508
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC97.01503207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891079QMedicaid
NC110214672Medicare PIN
NC891079QMedicaid
NC2244495BMedicare PIN