Healthcare Provider Details

I. General information

NPI: 1942526173
Provider Name (Legal Business Name): MIKHAIL JOUTOVSKY D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2010
Last Update Date: 03/31/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1341 HARRISON AVE STE 15
BUTTE MT
59701-4801
US

IV. Provider business mailing address

1341 HARRISON AVE STE 15
BUTTE MT
59701-4801
US

V. Phone/Fax

Practice location:
  • Phone: 406-299-2944
  • Fax: 406-299-2944
Mailing address:
  • Phone: 406-299-2944
  • Fax: 406-299-2944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number40557
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: