Healthcare Provider Details

I. General information

NPI: 1831867241
Provider Name (Legal Business Name): WOLPOE FACIAL PLASTIC SURGERY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

288 W HALEY SPRINGS RD STE 2A
BOZEMAN MT
59718-4184
US

IV. Provider business mailing address

4087 CEDARWOOD LN
BILLINGS MT
59106-9682
US

V. Phone/Fax

Practice location:
  • Phone: 406-281-4392
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW WOLPOE
Title or Position: OWNER PROVIDER
Credential: MD
Phone: 406-281-4392