Organization
AUGUSTO MONTALVO, MDSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AUGUSTO MONTALVO MD (PRESIDENT)
(847) 729-5000
Entity
Organization
Contact information
Practice address
2400 RAVINE WAY, SUITE#400, GLENVIEW, IL 60025-7652
(847) 729-5000
(847) 729-9506
Mailing address
2400 RAVINE WAY, SUITE#400, GLENVIEW, IL 60025-7652
(847) 729-5000
(847) 729-9506
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
336044595
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01632585
BLUE CROSS BLUE SHIELD
IL
Enumeration date
12/22/2006
Last updated
06/25/2008
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