Provider Demographics
NPI:1184705568
Name:MONTANILE, EGIDIO (DPM)
Entity type:Individual
Prefix:DR
First Name:EGIDIO
Middle Name:
Last Name:MONTANILE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19657
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-1657
Mailing Address - Country:US
Mailing Address - Phone:787-724-0871
Mailing Address - Fax:787-724-0886
Practice Address - Street 1:1413 FERNADEZ JUNCOS AVE.
Practice Address - Street 2:SUITE 1A
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00909
Practice Address - Country:US
Practice Address - Phone:787-724-0871
Practice Address - Fax:787-724-0886
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0039213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRT50886Medicare UPIN
PR071840BMedicare ID - Type Unspecified