Healthcare Provider Details

I. General information

NPI: 1598719064
Provider Name (Legal Business Name): ROBERT D NITSCHELM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 11/27/2023
Certification Date: 06/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 HERITAGE WAY STE 202
KALISPELL MT
59901-3127
US

IV. Provider business mailing address

160 HERITAGE WAY STE 202
KALISPELL MT
59901-3127
US

V. Phone/Fax

Practice location:
  • Phone: 406-752-8433
  • Fax: 406-756-6768
Mailing address:
  • Phone: 406-752-8433
  • Fax: 406-756-6768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4431
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11780
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: