Provider Demographics
NPI:1316033129
Name:IANNACONE, WILLIAM M (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:M
Last Name:IANNACONE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:310 WENDELL AVENUE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LEWISTOWN
Mailing Address - State:MT
Mailing Address - Zip Code:59457-2267
Mailing Address - Country:US
Mailing Address - Phone:406-538-1456
Mailing Address - Fax:406-538-1422
Practice Address - Street 1:310 WENDELL AVENUE
Practice Address - Street 2:SUITE 5
Practice Address - City:LEWISTOWN
Practice Address - State:MT
Practice Address - Zip Code:59457-2267
Practice Address - Country:US
Practice Address - Phone:406-538-1456
Practice Address - Fax:406-538-1422
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MT8732207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT99698OtherBC BS MONTANA
C60220Medicare UPIN