Provider Demographics
NPI:1023183993
Name:CAHILL, SUSAN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:CAHILL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 SUNNYVIEW LN
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3139
Mailing Address - Country:US
Mailing Address - Phone:406-250-4594
Mailing Address - Fax:406-755-1645
Practice Address - Street 1:40 2ND ST E
Practice Address - Street 2:SUITE 225
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-6110
Practice Address - Country:US
Practice Address - Phone:406-250-4594
Practice Address - Fax:406-755-1645
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT09363A00000X
NY000558-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0004301969Medicaid
MT0004301969Medicaid