Provider Demographics
NPI:1073508669
Name:MARTYAK, BARTHOLOMEW ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:BARTHOLOMEW
Middle Name:ANDREW
Last Name:MARTYAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4907
Mailing Address - Street 2:700 WEST KENT
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59806-4907
Mailing Address - Country:US
Mailing Address - Phone:406-541-3937
Mailing Address - Fax:406-541-1810
Practice Address - Street 1:3417 BUSCH ST
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-3505
Practice Address - Country:US
Practice Address - Phone:406-541-3937
Practice Address - Fax:406-541-1810
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MT7395207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT101626Medicaid
MT101626Medicaid
E13410Medicare UPIN