Healthcare Provider Details

I. General information

NPI: 1508044421
Provider Name (Legal Business Name): TIMOTHY GENE HIESTERMAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2008
Last Update Date: 07/26/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 W MAIN ST
BOZEMAN MT
59715-3356
US

IV. Provider business mailing address

2900 12TH AVE N STE 140W
BILLINGS MT
59101-7507
US

V. Phone/Fax

Practice location:
  • Phone: 406-237-5050
  • Fax:
Mailing address:
  • Phone: 406-237-5050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number52671
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number91472
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: