Healthcare Provider Details

I. General information

NPI: 1881640506
Provider Name (Legal Business Name): PAUL KILZER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 STOCKYARD RD BUILDING I200
MISSOULA MT
59808-1503
US

IV. Provider business mailing address

PO BOX 17528
MISSOULA MT
59808-7528
US

V. Phone/Fax

Practice location:
  • Phone: 406-728-8420
  • Fax: 406-541-8430
Mailing address:
  • Phone: 406-728-8420
  • Fax: 406-541-8430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number5181
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: