Individual
MICHAEL T MONTAGUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
1334 N LANSING AVE, TULSA, OK 74106-5907
(918) 587-2171
(918) 295-6155
Mailing address
1334 N LANSING AVE, TULSA, OK 74106-5907
(918) 587-2171
(918) 295-6155
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
1208
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100031840A
—
OK
05
—
100768880F
—
OK
05
—
100768880I
—
OK
05
—
100768880J
—
OK
01
—
37-1803
MEDICARE
OK
01
—
37-1832
MEDICARE
OK
01
—
37-1834
MEDICARE
OK
Enumeration date
08/09/2005
Last updated
06/19/2008
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