Healthcare Provider Details

I. General information

NPI: 1053725937
Provider Name (Legal Business Name): ROBERT SISE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2014
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 W MENDENHALL ST STE 202
BOZEMAN MT
59715-3566
US

IV. Provider business mailing address

96 N WEAVER ST UNIT 440
BELGRADE MT
59714-7018
US

V. Phone/Fax

Practice location:
  • Phone: 406-219-7233
  • Fax:
Mailing address:
  • Phone: 406-219-7233
  • Fax: 888-798-0145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMED-PHYS-LIC-67292
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberMED-PHYS-LIC-67292
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberMEDPHYSLIC67292
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: