Individual
MS. GINA MONTELEONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
44344 DEQUINDRE RD STE 210, STERLING HEIGHTS, MI 48314-1039
(586) 323-4200
(586) 843-3940
Mailing address
20952 E 12 MILE RD, SUITE 200, SAINT CLAIR SHORES, MI 48081-3200
(586) 771-4820
(586) 771-6620
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
5601003146
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CB9133
RAILROAD MEDICARE
MI
01
—
GL003146
BCBSM
MI
Enumeration date
12/28/2006
Last updated
07/21/2022
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