Provider Demographics
NPI:1447329933
Name:MONTPETIT, MICHELLE C (MD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:C
Last Name:MONTPETIT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 N WINFIELD RD STE 500
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-1379
Mailing Address - Country:US
Mailing Address - Phone:630-232-2800
Mailing Address - Fax:630-933-3626
Practice Address - Street 1:25 N WINFIELD RD STE 500
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-1379
Practice Address - Country:US
Practice Address - Phone:630-232-2800
Practice Address - Fax:630-933-3626
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036102528207RC0000X, 207RA0001X
IL036-102528207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL206147OtherMEDICARE PTAN (GROUP)
IL206147054OtherMEDICARE PTAN (INDIVIDUAL)
IL036102528Medicaid
ILK27055Medicare ID - Type Unspecified
I19554Medicare UPIN
ILK11550Medicare ID - Type Unspecified
IL206147054OtherMEDICARE PTAN (INDIVIDUAL)