Healthcare Provider Details

I. General information

NPI: 1508920802
Provider Name (Legal Business Name): SHAHAB SAMIEIAN ND
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 04/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 HARRISON AVE
BUTTE MT
59701-5406
US

IV. Provider business mailing address

1820 HARRISON AVE
BUTTE MT
59701-5406
US

V. Phone/Fax

Practice location:
  • Phone: 406-723-6609
  • Fax: 406-782-0200
Mailing address:
  • Phone: 406-723-6609
  • Fax: 406-299-3727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number28
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: