Healthcare Provider Details

I. General information

NPI: 1497287775
Provider Name (Legal Business Name): AMANDA KULL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 HIGHLAND BLVD STE 1160
BOZEMAN MT
59715-6905
US

IV. Provider business mailing address

915 HIGHLAND BLVD
BOZEMAN MT
59715-6902
US

V. Phone/Fax

Practice location:
  • Phone: 406-414-3780
  • Fax:
Mailing address:
  • Phone: 406-556-9798
  • Fax: 406-556-9795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number104963
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number10957163-1205
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMED-PHYS-LIC-104963
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: