Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 26424 | KY |
Y | 2080P0203X | Pediatric Critical Care Doctor | 26424 | KY |
NPI | 1033193446 |
---|---|
Provider Name | Vicki Lee Montgomery |
First Address | Chicago, IL 60677-6879 |
Second Address | Louisville, KY 40202-1831 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2005 |
Last Update Date | 26/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100374690A | (05) | IN |
64264245 | (05) | KY |
E82178 | (02) |