Provider Demographics
NPI:1700084407
Name:MONK, DAVID C (O TR)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:C
Last Name:MONK
Suffix:
Gender:M
Credentials:O TR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W8519 GLACIAL DR
Mailing Address - Street 2:
Mailing Address - City:WHITEWATER
Mailing Address - State:WI
Mailing Address - Zip Code:53190-4158
Mailing Address - Country:US
Mailing Address - Phone:262-374-1256
Mailing Address - Fax:
Practice Address - Street 1:W8519 GLACIAL DR
Practice Address - Street 2:
Practice Address - City:WHITEWATER
Practice Address - State:WI
Practice Address - Zip Code:53190-4158
Practice Address - Country:US
Practice Address - Phone:262-374-1256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor