Healthcare Provider Details

I. General information

NPI: 1255726469
Provider Name (Legal Business Name): WHITNEY KAY HASEMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2015
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2875 TINA AVE STE 102
MISSOULA MT
59808-1582
US

IV. Provider business mailing address

CPG INTERNAL MEDICINE 2825 FORT MISSOULA ROAD, BUILDING 1, SUITE 217
MISSOULA MT
59804
US

V. Phone/Fax

Practice location:
  • Phone: 406-272-3746
  • Fax: 406-303-3308
Mailing address:
  • Phone: 406-327-3850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number10094279-1205
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number10094279-8905
License Number StateUT
# 4
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberMED-PHYS-LIC-89204
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: