Provider Demographics
NPI:1013039767
Name:MITGANG, ROBERT NEWTON (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:NEWTON
Last Name:MITGANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3788 HWY. 89 SOUTH
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:MT
Mailing Address - Zip Code:59047-9156
Mailing Address - Country:US
Mailing Address - Phone:406-333-4228
Mailing Address - Fax:
Practice Address - Street 1:1892 WILLIAMS ST
Practice Address - Street 2:VA MONTANA HCS
Practice Address - City:FORT HARRISON
Practice Address - State:MT
Practice Address - Zip Code:59636
Practice Address - Country:US
Practice Address - Phone:406-447-7307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG10804207T00000X
MT8477207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1130338Medicare ID - Type Unspecified
A-38085Medicare UPIN