Provider Demographics
NPI:1447710504
Name:MONSALVE DIAZ, PEDRO FRANCISCO (MD)
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:FRANCISCO
Last Name:MONSALVE DIAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PEDRO
Other - Middle Name:
Other - Last Name:MONSALVE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:92 SW 3RD ST APT 4906
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-3390
Mailing Address - Country:US
Mailing Address - Phone:207-440-8581
Mailing Address - Fax:
Practice Address - Street 1:2799 W GRAND BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2689
Practice Address - Country:US
Practice Address - Phone:313-916-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-23
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MN73561207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program