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General NPI Number Information
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NPI Number | 1982618112
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Entity Type | Individual
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Provider Name | SAMUEL C. BIELIGK M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 12/26/2024
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Provider Practice Location Address
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Address Line | 415 6TH ST
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City | LEWISTON
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State | ID
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Zip | 83501
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Country | US
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Telephone | 208-743-7612
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Fax | 208-746-4802
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Provider Business Mailing Address
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Address Line | 415 6TH STREET ATTN: PHYSICIAN SERVICES
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City | LEWISTON
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State | ID
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Zip | 83501-2434
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Country | US
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Telephone | 208-750-7462
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Fax | 208-750-7467
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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 | D57659
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number | 2008010215
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MC-2661
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License Number State | ID
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