Healthcare Provider Details

I. General information

NPI: 1023251345
Provider Name (Legal Business Name): MELANIE PITTARD D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2009
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 SUNNYVIEW LN
KALISPELL MT
59901-3129
US

IV. Provider business mailing address

PO BOX 24823
SEATTLE WA
98124-0823
US

V. Phone/Fax

Practice location:
  • Phone: 425-407-1500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number29627
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberDO218124
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: