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1588669576

NPI Code Detail

MEDICARE: DR. KENNETH L. GALEWYRICK MD

MEDICARE: DR. KENNETH L. GALEWYRICK 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	24799	WI
2	207P00000X	Emergency Medicine Physician	24799	WI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	47190	OTHER	WI	MEDICARE GROUP
3	00496	OTHER	WI	MEDICARE GROUP
5	080124104	OTHER		PALMETTO GBA RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1007586	OTHER		PREFERRED ONE
6	46Q67GA	OTHER		BCBS MN

General Provider Information

NPI Number	:	1588669576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH L. GALEWYRICK MD

Provider Business Mailing Address
First Line	:	PO BOX 262
Second Line	:
City	:	LIBERTY LAKE
State	:	WA
Zip	:	99019-0262
Country	:	US
Telephone Number	:	406-883-5680
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 13TH AVE E
Second Line	:
City	:	POLSON
State	:	MT
Zip	:	59860-5315
Country	:	US
Telephone Number	:	406-883-5680
Fax Number	:

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	07/24/2015

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Directions to “ DR. KENNETH L. GALEWYRICK MD” Practice Location

Language	Start Address	Practice Location

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