Provider Demographics
NPI:1932411063
Name:EMILIO F MONTERO MD PA
Entity Type:Organization
Organization Name:EMILIO F MONTERO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMILIO
Authorized Official - Middle Name:F
Authorized Official - Last Name:MONTERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-682-2117
Mailing Address - Street 1:1812 LAKELAND HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-3004
Mailing Address - Country:US
Mailing Address - Phone:863-682-2117
Mailing Address - Fax:863-683-7915
Practice Address - Street 1:1812 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-3004
Practice Address - Country:US
Practice Address - Phone:863-682-2117
Practice Address - Fax:863-683-7915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-06
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL193400000X174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME0016269Medicaid
FL53428Medicare PIN
FLD56511Medicare UPIN