Healthcare Provider Details

I. General information

NPI: 1578518916
Provider Name (Legal Business Name): KAE M SUKUT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 02/03/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 17TH ST W
BILLINGS MT
59102-1736
US

IV. Provider business mailing address

2510 17TH ST W
BILLINGS MT
59102-1736
US

V. Phone/Fax

Practice location:
  • Phone: 406-245-3238
  • Fax: 406-248-6814
Mailing address:
  • Phone: 406-245-3238
  • Fax: 406-248-6814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number427
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: