Provider Demographics
NPI:1841154804
Name:GRAY, MONTREAVOUS
Entity type:Individual
Prefix:
First Name:MONTREAVOUS
Middle Name:
Last Name:GRAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3819 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53206-3310
Mailing Address - Country:US
Mailing Address - Phone:608-344-9494
Mailing Address - Fax:
Practice Address - Street 1:811 E WASHINGTON AVE STE 400
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-4028
Practice Address - Country:US
Practice Address - Phone:608-344-9494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-12-15
Last Update Date:2025-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI343900000X, 171WV0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WV0202XOther Service ProvidersContractorVehicle Modifications
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)