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General NPI Number Information
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NPI Number | 1407803232
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Entity Type | Organization
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Legal Business Name | CHISDAK OB-GYN
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Dates
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Enumeration Date | 05/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2132 BROADWATER AVE STE A1
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City | BILLINGS
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State | MT
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Zip | 59102-4778
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Country | US
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Telephone | 406-556-4649
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Fax | 406-556-7083
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Provider Business Mailing Address
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Address Line | 1648 ELLIS ST SUITE 201
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City | BOZEMAN
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State | MT
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Zip | 59715-8810
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Country | US
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Telephone | 406-556-4649
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Fax | 406-556-7083
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Authorized Official
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Title or Position | PHYSICIAN
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Name | JAMI CHISDAK
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Credential | M.D.
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Telephone | 406-556-4649
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 9885
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License Number State | MT
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