Healthcare Provider Details

I. General information

NPI: 1073535019
Provider Name (Legal Business Name): KATHRYN BORGENICHT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 12/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 HIGHLAND BLVD STE 4500
BOZEMAN MT
59715-6903
US

IV. Provider business mailing address

915 HIGHLAND BLVD
BOZEMAN MT
59715-6902
US

V. Phone/Fax

Practice location:
  • Phone: 406-522-2400
  • Fax:
Mailing address:
  • Phone: 406-522-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number9821
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number9821
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: