Basic Information
| Provider Information | |||||||||
| NPI: | 1649284712 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MONTENEGRO | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | PALENCIA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 4TH AVE SE | ||||||||
| Address2: | |||||||||
| City: | GLENWOOD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563341820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3206344521 | ||||||||
| FaxNumber: | 3206342262 | ||||||||
| Practice Location | |||||||||
| Address1: | 10 4TH AVE SE | ||||||||
| Address2: | |||||||||
| City: | GLENWOOD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563341820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3206344521 | ||||||||
| FaxNumber: | 3206342262 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 44463 | MN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 142928 | 01 | UCARE | OTHER | 01-10121 | 01 | MEDICA | OTHER | 01-10122 | 01 | MEDICA | OTHER | 133M5MO | 01 | MN | BLUE CROSS | OTHER | HP36961 | 01 | HEALTH PARTNERS | OTHER | 39-44354 | 01 | MEDICA | OTHER | 1032853 | 01 | PREFERRED ONE | OTHER | 01-10120 | 01 | MEDICA | OTHER | 1705983 | 01 | ARAZ | OTHER |