Provider Demographics
NPI:1902598758
Name:MANUEL MONTES DE OCA MD PC
Entity Type:Organization
Organization Name:MANUEL MONTES DE OCA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTES DE OCA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-360-0503
Mailing Address - Street 1:625 W MADISON ST APT 3711
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-2747
Mailing Address - Country:US
Mailing Address - Phone:561-360-0503
Mailing Address - Fax:
Practice Address - Street 1:3153 W FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-2809
Practice Address - Country:US
Practice Address - Phone:773-395-4600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Multi-Specialty