Provider Demographics
NPI:1871770537
Name:MONTEVECCHI, MAURO VIDO (MD)
Entity type:Individual
Prefix:DR
First Name:MAURO
Middle Name:VIDO
Last Name:MONTEVECCHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 E NORRIS DR
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-1605
Mailing Address - Country:US
Mailing Address - Phone:815-434-0276
Mailing Address - Fax:
Practice Address - Street 1:1050 E NORRIS DR
Practice Address - Street 2:SUITE 1B
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-1605
Practice Address - Country:US
Practice Address - Phone:815-434-0276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-24
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036122236207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease