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NPI Code Detail

MEDICARE: MARK S KREISBERG MD

MEDICARE: MARK S KREISBERG 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
1208M00000XHospitalist Physician9555MT
2207R00000XInternal Medicine Physician9555MT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
19555OTHERMTLICENSE

General Provider Information

NPI Number : 1467453324
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK S KREISBERG MD
Provider Business Mailing Address
First Line : 2475 E BROADWAY ST
Second Line :
City : HELENA
State : MT
Zip : 59601-4928
Country : US
Telephone Number : 406-442-2480
Fax Number :
Provider Business Practice Location Address
First Line : 2475 E BROADWAY ST
Second Line :
City : HELENA
State : MT
Zip : 59601-4928
Country : US
Telephone Number : 406-442-2480
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2005
Last Update Date : 07/13/2015

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