Provider Demographics
NPI:1073521654
Name:VLASES, MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:VLASES
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 1:931 HIGHLAND BLVD STE 3220
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-6912
Mailing Address - Country:US
Mailing Address - Phone:406-522-2400
Mailing Address - Fax:
Practice Address - Street 1:931 HIGHLAND BLVD STE 3220
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6912
Practice Address - Country:US
Practice Address - Phone:406-522-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10638207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000098685OtherBLUE CROSS OF MT
P00218213OtherMEDICARE RAILROAD
MT0089080Medicaid
I15082Medicare UPIN
MT0089080Medicaid
000084449Medicare PIN