MEDICARE: JESSIE LYN KAUTZMAN 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	207Q00000X	Family Medicine Physician	10036	MT
2	208D00000X	General Practice Physician	10036	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1366424558	OTHER	MT	NPI

General Provider Information

NPI Number	:	1366424558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSIE LYN KAUTZMAN MD

Provider Business Mailing Address
First Line	:	401 W PENNSYLVANIA AVE STE 300
Second Line	:
City	:	ANACONDA
State	:	MT
Zip	:	59711-1999
Country	:	US
Telephone Number	:	406-563-8500
Fax Number	:	406-563-8694

Provider Business Practice Location Address
First Line	:	401 S ALABAMA ST STE 6A
Second Line	:
City	:	BUTTE
State	:	MT
Zip	:	59701-2358
Country	:	US
Telephone Number	:	406-563-7239
Fax Number	:	406-782-2890

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

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	04/01/2019

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