MEDICARE: AIM HEALTHCARE PROVIDERS MT, PLLC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1063356012
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AIM HEALTHCARE PROVIDERS MT, PLLC

Provider Business Mailing Address
First Line	:	5525 GRANITE PKWY STE 780
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75024-4364
Country	:	US
Telephone Number	:	480-494-2465
Fax Number	:

Provider Business Practice Location Address
First Line	:	2425 W CENTRAL AVE STE 203&205
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59801-6402
Country	:	US
Telephone Number	:	480-494-2465
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING DIRECTOR
Name	:	KELLY KARANIUK
Credential	:
Telephone Number	:	480-447-6841

Provider Enumeration Date	:	04/17/2026
Last Update Date	:	04/17/2026

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