Individual
MICHAEL THOMAS MONTICCIOLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1100 E NORRIS DR, OTTAWA, IL 61350
(815) 433-3100
(815) 433-0879
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
02008680A
IN
207P00000X
Emergency Medicine Physician
Primary
036172367
IL
207P00000X
Emergency Medicine Physician
5101020253
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/25/2013
Last updated
11/20/2025
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