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Contact Information

MICHAEL T MONTICCIOLO, DO
1100 E NORRIS DR
OTTAWA, IL61350
 Phone: 815-433-3100
 Fax: 815-433-0879
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Emergency Medicine

207P00000X 93 Physician/Emergency Medicine
 

Student in an Organized Health Care Education/Training Program

390200000X
Indicates primary specialty

NPI Profile & details for MICHAEL T MONTICCIOLO · (Male)

NPI # 1689914954
Status Active
Credentials DO (Doctor of Osteopathic)
Entity Individual
Enumeration date 02/25/2013
Last updated 11/20/2025 - About 7 months ago
Sole proprietor 1 Yes
Identifiers
  • IL License # 036172367
  • IN License # 02008680A
  • MI License # 5101020253
Hospital affiliation(s)
  • SAINT JOSEPH MERCY LIVINGSTON HOSPITAL - (Acute Care)
    620 BYRON RD
    HOWELL, MI 48843
  • ST MARY MERCY HOSPITAL - (Acute Care)
    36475 FIVE MILE ROAD
    LIVONIA, MI 48154
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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