Augusto Montalvo, MDSC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

336044595 Issued in IL

Legal business name

AUGUSTO MONTALVO, MDSC

Practice address

2400 Ravine Way
Suite#400
Glenview, IL 60025-7652

Phone

(847) 729-5000

Fax

(847) 729-9506

NPI assigned

Dec 22, 2006

Last updated

Jun 25, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Augusto Montalvo, MD

Title

President

Phone

(847) 729-5000

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214352000000",
    "number": "1346305067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 RAVINE WAY",
            "address_2": "SUITE#400",
            "city": "GLENVIEW",
            "state": "IL",
            "postal_code": "600257652",
            "telephone_number": "847-729-5000",
            "fax_number": "847-729-9506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 RAVINE WAY",
            "address_2": "SUITE#400",
            "city": "GLENVIEW",
            "state": "IL",
            "postal_code": "600257652",
            "telephone_number": "847-729-5000",
            "fax_number": "847-729-9506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUGUSTO MONTALVO, MDSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-22",
        "last_updated": "2008-06-25",
        "status": "A",
        "authorized_official_last_name": "MONTALVO",
        "authorized_official_first_name": "AUGUSTO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-729-5000",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IL",
            "license": "336044595",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "01632585",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dermatology Physician in Glenview, IL
• Providers in Glenview, IL by specialty
• Dermatology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.