Individual
MR. TIMOTHY JOSEPH MONTAG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
9645 GROVE CIRCLE NORTH, STE 200, MAPLE GROVE, MN 55369-4466
(763) 201-8191
(763) 201-8192
Mailing address
9645 GROVE CIRCLE NORTH, STE 200, MAPLE GROVE, MN 55369-4466
(763) 201-8191
(763) 201-8192
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1735
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
045N0MO
BLUE CROSS BLUE SHIELD
—
05
—
058133000
—
MN
Enumeration date
12/01/2006
Last updated
04/30/2018
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