Male or Other

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)

Code

207Q00000X

Primary Taxonomy

Yes

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

Provider Address

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