Individual
DR. TY MONTGOMERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2451 INTELLIPLEX DR, SHELBYVILLE, IN 46176-8580
(317) 392-3211
Mailing address
PO BOX 58, LIMA, OH 45802-0058
(866) 942-0799
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
01047114A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000204615
ANTHEM BCBS
IN
05
—
200286380
—
IN
Enumeration date
03/08/2007
Last updated
03/10/2021
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