Provider Demographics
NPI:1023120144
Name:MONFILS, MICHAEL J (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:MONFILS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1181 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE
Mailing Address - State:IL
Mailing Address - Zip Code:61068-2416
Mailing Address - Country:US
Mailing Address - Phone:815-562-5549
Mailing Address - Fax:815-562-5231
Practice Address - Street 1:1181 N 8TH ST
Practice Address - Street 2:
Practice Address - City:ROCHELLE
Practice Address - State:IL
Practice Address - Zip Code:61068
Practice Address - Country:US
Practice Address - Phone:815-562-5549
Practice Address - Fax:815-562-5231
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-110160208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400490304OtherMEDICARE
IL036110160Medicaid
DB8908/P00135062OtherRAILROAD MEDICARE