Provider Demographics
NPI:1154323731
Name:MONTGOMERY, TRAVIS J (DPM)
Entity type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:J
Last Name:MONTGOMERY
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:12315 HANCOCK ST STE 24
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5885
Mailing Address - Country:US
Mailing Address - Phone:317-708-3732
Mailing Address - Fax:888-316-7962
Practice Address - Street 1:13421 OLD MERIDIAN ST STE 202
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-1411
Practice Address - Country:US
Practice Address - Phone:317-850-8522
Practice Address - Fax:888-316-7962
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2025-05-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN07001006A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200525150Medicaid
IN300102111Medicaid
IN200525150Medicaid
INV05927Medicare UPIN
INP00265351Medicare PIN