Provider Demographics
NPI:1457629586
Name:MONTILLA, JORGE X (MD)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:X
Last Name:MONTILLA
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 1:6700 SW 122ND DR
Mailing Address - Street 2:
Mailing Address - City:PINECREST
Mailing Address - State:FL
Mailing Address - Zip Code:33156-5459
Mailing Address - Country:US
Mailing Address - Phone:786-652-0023
Mailing Address - Fax:786-625-4933
Practice Address - Street 1:11760 SW 40TH ST STE 122
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3589
Practice Address - Country:US
Practice Address - Phone:786-652-0023
Practice Address - Fax:786-625-4933
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-04
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09001900207RC0000X
WI64538-20207RC0000X
FLME136850207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100053637Medicaid
FL100239700Medicaid
FL128227000Medicaid