Provider Demographics
NPI:1467483412
Name:POPOVICH, KEITH J (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:J
Last Name:POPOVICH
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 1:505 W PARK ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-9106
Mailing Address - Country:US
Mailing Address - Phone:406-782-8988
Mailing Address - Fax:406-782-6243
Practice Address - Street 1:505 W PARK ST
Practice Address - Street 2:SUITE A
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-9106
Practice Address - Country:US
Practice Address - Phone:406-782-8988
Practice Address - Fax:406-782-6243
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT6636207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0108375Medicaid
MT0000000031OtherBLUE CROSS BLUE SHEILD
MT9989135Medicaid
MT0000000031OtherBLUE CROSS BLUE SHEILD
MT0108375Medicaid