Provider Demographics
NPI:1396943635
Name:MONTOYA BARRAZA, ROBERTO CARLOS (MD)
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:CARLOS
Last Name:MONTOYA BARRAZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ROBERTO
Other - Middle Name:CARLOS
Other - Last Name:MONTOYA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3701 ALGONQUIN RD STE 900
Mailing Address - Street 2:
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-3193
Mailing Address - Country:US
Mailing Address - Phone:847-577-0620
Mailing Address - Fax:
Practice Address - Street 1:3701 ALGONQUIN RD STE 900
Practice Address - Street 2:
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-3193
Practice Address - Country:US
Practice Address - Phone:847-577-0620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-143747207RH0003X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program