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General NPI Number Information
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NPI Number | 1699980367
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Entity Type | Individual
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Provider Name | MARK ANDREW HIESTERMAN D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 08/06/2024
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Provider Practice Location Address
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Address Line | 221 5TH AVE S
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City | GLASGOW
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State | MT
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Zip | 59230-2600
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Country | US
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Telephone | 406-228-3536
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Fax |
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Provider Business Mailing Address
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Address Line | 16201 E INDIANA AVE SUITE 3100
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City | SPOKANE VALLEY
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State | WA
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Zip | 99216-2830
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Country | US
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Telephone | 509-891-8904
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Fax | 509-344-3104
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | OP60226290
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 131349
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License Number State | MT
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