Individual
MR. TRAVIS MONTGOMERY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RNFA
Contact information
Practice address
4400 W 95TH ST STE 308, OAK LAWN, IL 60453-2660
(708) 346-4040
(708) 346-3287
Mailing address
9500 BORMET DR STE 204, MOKENA, IL 60448-8399
(708) 346-4044
(708) 346-3287
Taxonomy
Speciality
Code
Description
License number
State
163WR0006X
Registered Nurse First Assistant
041472495
IL
246ZC0007X
Surgical Assistant
Primary
238000654
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041472495
IL RN LICENSE
IL
01
—
238000654
IL SA LICENSE
IL
Enumeration date
08/27/2018
Last updated
04/08/2020
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