Provider Demographics
NPI:1174502173
Name:WESTENFELDER, KARL R (MD)
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:R
Last Name:WESTENFELDER
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 1:2875 TINA AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-9039
Mailing Address - Country:US
Mailing Address - Phone:406-728-3366
Mailing Address - Fax:406-728-0651
Practice Address - Street 1:2875 TINA AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-9039
Practice Address - Country:US
Practice Address - Phone:406-728-3366
Practice Address - Fax:406-728-0651
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MT8443208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0063947Medicaid
MTG46657Medicare UPIN
MT000083460Medicare ID - Type Unspecified