Provider Demographics
NPI:1700126562
Name:MONTEMURRO, ANTONIO IPPOLITO (DPM)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:IPPOLITO
Last Name:MONTEMURRO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6308 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53143-5031
Mailing Address - Country:US
Mailing Address - Phone:262-656-3313
Mailing Address - Fax:262-653-5850
Practice Address - Street 1:9697 SAINT CATHERINES DR STE 300
Practice Address - Street 2:
Practice Address - City:PLEASANT PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53158-2118
Practice Address - Country:US
Practice Address - Phone:262-656-3338
Practice Address - Fax:262-656-3368
Is Sole Proprietor?:No
Enumeration Date:2013-02-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005538213EP1101X
WI1031-25213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1700126562Medicaid
WIK400163324OtherMEDICARE