Individual
PAUL MONTGOMERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4440 W 95TH ST DEPT OF, OAK LAWN, IL 60453-2600
(708) 684-5503
(708) 684-2675
Mailing address
29373 NETWORK PL, CHICAGO, IL 60673-1293
(847) 390-5900
Taxonomy
Speciality
Code
Description
License number
State
2085P0229X
Pediatric Radiology Physician
Primary
036-148104
IL
2085P0229X
Pediatric Radiology Physician
152482
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00025517704
UNIVERA
—
01
—
000510109013
BLUE SHIELD OF WESTERN NY
—
01
—
1524826CR
WORKERS COMPENSATION
NY
01
—
1609168
INDEPENDENT HEALTH
—
Enumeration date
12/02/2005
Last updated
12/10/2022
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