MEDICARE: CELIA ELLEN SEMRAD PA-C

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	363AM0700X	Medical Physician Assistant	MED-PAC-LIC-174225	MT

General Provider Information

NPI Number	:	1871428565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CELIA ELLEN SEMRAD PA-C

Provider Business Mailing Address
First Line	:	4283 BLACKSTONE CT
Second Line	:
City	:	MIDDLETON
State	:	WI
Zip	:	53562-4300
Country	:	US
Telephone Number	:	608-695-4707
Fax Number	:

Provider Business Practice Location Address
First Line	:	2230 N RESERVE ST STE 402
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59808-1364
Country	:	US
Telephone Number	:	406-721-0533
Fax Number	:

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

Provider Enumeration Date	:	06/15/2026
Last Update Date	:	06/15/2026

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