Provider Demographics
NPI:1528030400
Name:YAPUNCICH, KATHLEEN M (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:YAPUNCICH
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 1:3401 AVENUE E
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-6561
Mailing Address - Country:US
Mailing Address - Phone:406-281-8700
Mailing Address - Fax:406-281-8708
Practice Address - Street 1:3401 AVENUE E
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102
Practice Address - Country:US
Practice Address - Phone:406-281-8700
Practice Address - Fax:406-281-8708
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6398A208000000X
MN40846208000000X
MT68875208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN959216400Medicaid
MN959216400Medicaid
G79621Medicare UPIN
MN370003881Medicare PIN