Healthcare Provider Details

I. General information

NPI: 1902986227
Provider Name (Legal Business Name): NICK BLAVATSKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 S CRYSTAL ST SUITE 400
BUTTE MT
59701-1515
US

IV. Provider business mailing address

435 S CRYSTAL ST SUITE 400
BUTTE MT
59701-1515
US

V. Phone/Fax

Practice location:
  • Phone: 406-496-3400
  • Fax: 406-496-3401
Mailing address:
  • Phone: 406-496-3400
  • Fax: 406-496-3401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number8799
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: