Healthcare Provider Details

I. General information

NPI: 1780946954
Provider Name (Legal Business Name): KATHERINE VARGO KASAVANA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2012
Last Update Date: 07/21/2022
Certification Date: 01/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 SUNNYVIEW LN
KALISPELL MT
59901-3129
US

IV. Provider business mailing address

310 SUNNYVIEW LN
KALISPELL MT
59901-3129
US

V. Phone/Fax

Practice location:
  • Phone: 406-751-5310
  • Fax:
Mailing address:
  • Phone: 406-751-5310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number47545
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number47545
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: