Healthcare Provider Details

I. General information

NPI: 1063349470
Provider Name (Legal Business Name): HARRIS BAJWA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35401 MISSION DR
ST IGNATIUS MT
59865-7791
US

IV. Provider business mailing address

922 RIMINI CT
MISSOULA MT
59801-7043
US

V. Phone/Fax

Practice location:
  • Phone: 406-317-3751
  • Fax:
Mailing address:
  • Phone: 508-638-8417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: