Healthcare Provider Details

I. General information

NPI: 1093070278
Provider Name (Legal Business Name): LAURA SAGE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAURA MACDONALD MD

II. Dates (important events)

Enumeration Date: 07/12/2012
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1287 BURNS WAY
KALISPELL MT
59901-3109
US

IV. Provider business mailing address

1287 BURNS WAY
KALISPELL MT
59901-3109
US

V. Phone/Fax

Practice location:
  • Phone: 406-858-6802
  • Fax: 406-752-8135
Mailing address:
  • Phone: 406-858-6802
  • Fax: 406-752-8135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMED-PHYS-LIC-103234
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number48571
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: