Provider Demographics
NPI:1164671772
Name:M. CALANTHE WILSON-PANT, M.D., PLLC
Entity Type:Organization
Organization Name:M. CALANTHE WILSON-PANT, M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:M.
Authorized Official - Middle Name:CALANTHE
Authorized Official - Last Name:WILSON-PANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-782-1572
Mailing Address - Street 1:700 W GOLD ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-2320
Mailing Address - Country:US
Mailing Address - Phone:406-782-1572
Mailing Address - Fax:406-723-7302
Practice Address - Street 1:700 W GOLD ST
Practice Address - Street 2:SUITE A
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-2320
Practice Address - Country:US
Practice Address - Phone:406-782-1572
Practice Address - Fax:406-723-7302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-18
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT8207207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT8207OtherLICENSE