Provider Demographics
NPI:1457303265
Name:JANCZEWSKI, KRISTIN H (MD)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:H
Last Name:JANCZEWSKI
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 1:2835 FORT MISSOULA RD
Mailing Address - Street 2:#306
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-7423
Mailing Address - Country:US
Mailing Address - Phone:406-541-2570
Mailing Address - Fax:406-541-2573
Practice Address - Street 1:2835 FORT MISSOULA RD
Practice Address - Street 2:#306
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-7423
Practice Address - Country:US
Practice Address - Phone:406-541-2570
Practice Address - Fax:406-541-2573
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT8688174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0062169Medicaid
MTG50934Medicare UPIN