MEDICARE: DR. KELLY KRISTINE BERKRAM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	11770	MT
2	207Q00000X	Family Medicine Physician	11740	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1497825178	OTHER	MT	BCBS

General Provider Information

NPI Number	:	1497825178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLY KRISTINE BERKRAM M.D.

Provider Business Mailing Address
First Line	:	28 VILLAGE LOOP RD
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-2793
Country	:	US
Telephone Number	:	406-571-3909
Fax Number	:	406-285-8088

Provider Business Practice Location Address
First Line	:	28 VILLAGE LOOP RD
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-2793
Country	:	US
Telephone Number	:	406-571-3909
Fax Number	:	406-285-8088

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	01/13/2025

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