Provider Demographics
NPI:1497825178
Name:BERKRAM, KELLY KRISTINE (MD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:KRISTINE
Last Name:BERKRAM
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 1:1280 BURNS WAY
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3110
Mailing Address - Country:US
Mailing Address - Phone:406-755-5266
Mailing Address - Fax:406-755-0228
Practice Address - Street 1:1280 BURNS WAY
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3110
Practice Address - Country:US
Practice Address - Phone:406-755-5266
Practice Address - Fax:406-755-0228
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01061008A207Q00000X
MT11740207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1497825178OtherBCBS
MT1497825178Medicaid
M011000274Medicare PIN