MEDICARE: THOMAS ORIGITANO MD PHD

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	207T00000X	Neurological Surgery Physician	36072034	IL
2	207T00000X	Neurological Surgery Physician	12626	MT

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

General Provider Information

NPI Number	:	1841277720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS ORIGITANO MD PHD

Provider Business Mailing Address
First Line	:	200 COMMONS WAY STE B
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-1915
Country	:	US
Telephone Number	:	406-752-5170
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 COMMONS WAY STE B
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-1915
Country	:	US
Telephone Number	:	406-752-5170
Fax Number	:

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

Provider Enumeration Date	:	12/30/2005
Last Update Date	:	11/27/2023

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