MEDICARE: MICHELE A DANICICH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	MT8723	MT

General Provider Information

NPI Number	:	1053321273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELE A DANICICH MD

Provider Business Mailing Address
First Line	:	PO BOX 12
Second Line	:
City	:	LIBERTY LAKE
State	:	WA
Zip	:	99019-0012
Country	:	US
Telephone Number	:	406-329-5781
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 N ORANGE ST STE 304
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59802-2951
Country	:	US
Telephone Number	:	406-329-5781
Fax Number	:	406-327-3331

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	05/11/2021

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Directions to “ MICHELE A DANICICH MD” Practice Location

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