Provider Demographics
NPI:1235176173
Name:KADRI, KATHIE FAY (MD)
Entity Type:Individual
Prefix:
First Name:KATHIE
Middle Name:FAY
Last Name:KADRI
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 1:327 EDITH ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-3915
Mailing Address - Country:US
Mailing Address - Phone:406-672-8655
Mailing Address - Fax:
Practice Address - Street 1:327 EDITH ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-3915
Practice Address - Country:US
Practice Address - Phone:406-672-8655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10001207R00000X
WAMD60245038207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000095798OtherBCBS
MT011002967Medicare PIN