Provider Demographics
NPI:1871605477
Name:MONTANO, RONILO C (MD)
Entity type:Individual
Prefix:
First Name:RONILO
Middle Name:C
Last Name:MONTANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28351 SCHOENHERR RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-6331
Mailing Address - Country:US
Mailing Address - Phone:586-393-6500
Mailing Address - Fax:586-393-6515
Practice Address - Street 1:28351 SCHOENHERR RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-6331
Practice Address - Country:US
Practice Address - Phone:586-393-6500
Practice Address - Fax:586-393-6515
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRM062506207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM68180003Medicare PIN
MIG41848Medicare UPIN