Individual
DR. DOUG ALAN MONTEITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2740 W FOSTER AVE, #417, CHICAGO, IL 60625-3500
(773) 907-3060
(773) 907-3061
Mailing address
2740 W FOSTER AVE, #417, CHICAGO, IL 60625-3500
(773) 907-3060
(773) 907-3061
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
036102050
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036102050
—
IL
01
—
BLUE SHIELD PROVIDER
01633446
IL
01
—
COMM PROVIDER #
203712521
IL
01
—
RR MEDICARE #
P00023316
IL
Enumeration date
11/15/2006
Last updated
05/07/2013
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