Provider Demographics
NPI:1669554663
Name:MONTELLANO, FRANKLIN DEL ROSARIO (MD)
Entity type:Individual
Prefix:
First Name:FRANKLIN
Middle Name:DEL ROSARIO
Last Name:MONTELLANO
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:PO BOX 1048
Mailing Address - Street 2:DEPT 1000
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-7048
Mailing Address - Country:US
Mailing Address - Phone:847-495-1617
Mailing Address - Fax:847-538-4866
Practice Address - Street 1:300 RANDALL RD
Practice Address - Street 2:PATHOLOGY DEPT
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-4200
Practice Address - Country:US
Practice Address - Phone:630-232-8322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036089636207ZP0102X
TXU8487207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036089636 3Medicaid
IL220033618OtherRAILROAD MEDICARE
IL036089636 3Medicaid