Provider Demographics
NPI:1073535019
Name:BORGENICHT, KATHRYN (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:
Last Name:BORGENICHT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 HIGHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-6902
Mailing Address - Country:US
Mailing Address - Phone:406-522-2400
Mailing Address - Fax:
Practice Address - Street 1:905 HIGHLAND BLVD STE 4500
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6903
Practice Address - Country:US
Practice Address - Phone:406-522-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9821207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0091409Medicaid
P00205974OtherMEDICARE RAILROAD
MT000098471OtherBLUE CROSS MT
MT0091409Medicaid
MT000098471OtherBLUE CROSS MT
A47862Medicare UPIN