Michael T. Montague PAC
Family Medicine Physician in Tulsa, OK(View on Map)
Full Name
Michael T Montague PAC
NPI Number
1316948656
NPI Type
Individual Provider
Gender
Male
Enumeration Date
08/09/2005
Specialties
(Taxonomies)Licenses
State
Oklahoma
License Number
1208
Contact
Information
Purpose
Mailing
Location
Address
1334 N LANSING AVE
1334 N LANSING AVE
City
Tulsa
Tulsa
State
OK
OK
Postal Code
74106-5907
74106-5907
Country
US
US
Telephone Number
(918) 587-2171
(918) 587-2171
Identifiers
Identifier
37-1803
100768880F
100768880I
100768880J
37-1832
37-1834
100031840A
Identifier State
OK
OK
OK
OK
OK
OK
OK
Identifier Issuer
MEDICARE
Unknown
Unknown
Unknown
MEDICARE
MEDICARE
Unknown
Provider data last refreshed from NPPES NPI registry on 11/19/2024
Data last updated by provider on 06/19/2008