Provider Demographics
NPI:1255144523
Name:MONTALVO, MICHAEL (ASSOCIATE OF ARTS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MONTALVO
Suffix:
Gender:M
Credentials:ASSOCIATE OF ARTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3867 W 157TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-5825
Mailing Address - Country:US
Mailing Address - Phone:216-773-9533
Mailing Address - Fax:
Practice Address - Street 1:3867 W 157TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-5825
Practice Address - Country:US
Practice Address - Phone:216-773-9533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist