Provider Demographics
NPI:1053046714
Name:MONTOYA NOVOA, JUAN JOSE (MD)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:JOSE
Last Name:MONTOYA NOVOA
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 1:114 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:MI
Mailing Address - Zip Code:48847-1132
Mailing Address - Country:US
Mailing Address - Phone:989-875-4166
Mailing Address - Fax:989-875-5168
Practice Address - Street 1:114 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:MI
Practice Address - Zip Code:48847-1132
Practice Address - Country:US
Practice Address - Phone:989-875-4166
Practice Address - Fax:989-875-5168
Is Sole Proprietor?:No
Enumeration Date:2022-07-18
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301514500207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine