Provider Demographics
NPI:1053321265
Name:GUNLIKSON, RYAN THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:THOMAS
Last Name:GUNLIKSON
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:PO BOX 3031
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59903-3031
Mailing Address - Country:US
Mailing Address - Phone:406-755-2823
Mailing Address - Fax:406-257-4820
Practice Address - Street 1:2000 HOSPITAL WAY
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937
Practice Address - Country:US
Practice Address - Phone:406-862-5575
Practice Address - Fax:406-862-3797
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT8596208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0159171Medicaid
MT000085556Medicare PIN
MT0159171Medicaid