Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | MD12614 | RI |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | MD12614 | RI |
NPI | 1093932972 |
---|---|
Provider Name | Keith Monchik |
First Address | Providence, RI 02908-5794 |
Second Address | Providence, RI 02908-5794 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2007 |
Last Update Date | 16/06/2015 |