MEDICARE: ROBERT D NITSCHELM MD

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	4431	SD
2	207Q00000X	Family Medicine Physician	11780	MT

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	080155590	OTHER	SD	RR MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0005763	OTHER	SD	WELLMARK
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	4431	OTHER	SD	DAKOTACARE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	0005747	OTHER	SD	WELLMARK

NPI Number	:	1598719064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT D NITSCHELM MD

Provider Business Mailing Address
First Line	:	160 HERITAGE WAY STE 202
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-3127
Country	:	US
Telephone Number	:	406-752-8433
Fax Number	:	406-756-6768

Provider Business Practice Location Address
First Line	:	160 HERITAGE WAY STE 202
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-3127
Country	:	US
Telephone Number	:	406-752-8433
Fax Number	:	406-756-6768

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

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	11/27/2023

160 HERITAGE WAY STE 102
KALISPELL, MT
59901-3127

Practice Phone: 406-758-3244
Practice Fax: 406-758-5166

160 HERITAGE WAY STE 202
KALISPELL, MT
59901-3127