Healthcare Provider Details

I. General information

NPI: 1821083015
Provider Name (Legal Business Name): BURKE E HANSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 15TH AVE S STE 201
GREAT FALLS MT
59405-4334
US

IV. Provider business mailing address

401 15TH AVE S STE 201
GREAT FALLS MT
59405-4334
US

V. Phone/Fax

Practice location:
  • Phone: 406-727-2121
  • Fax: 406-727-2147
Mailing address:
  • Phone: 406-727-2121
  • Fax: 406-727-2147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number10081
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: