MEDICARE: MARK S WOLTANSKI 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	4975	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	:	1912934720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK S WOLTANSKI MD

Provider Business Mailing Address
First Line	:	PO BOX 7609
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59807-7609
Country	:	US
Telephone Number	:	406-721-5600
Fax Number	:	406-721-3907

Provider Business Practice Location Address
First Line	:	2901 BROOKS ST
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59801-7722
Country	:	US
Telephone Number	:	406-721-0918
Fax Number	:	406-721-1654

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

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	07/08/2007

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