Provider Demographics
NPI:1578518916
Name:SUKUT, KAE M (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KAE
Middle Name:M
Last Name:SUKUT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 17TH ST W
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-1736
Mailing Address - Country:US
Mailing Address - Phone:406-245-3238
Mailing Address - Fax:406-248-6814
Practice Address - Street 1:2510 17TH ST W
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-1736
Practice Address - Country:US
Practice Address - Phone:406-245-3238
Practice Address - Fax:406-248-6814
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT427363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1578518916Medicaid
POO475855OtherMEDICARE RAILROAD PTAN
MT97363OtherBLUE CROSS/BLUE SHIELD
DG9848OtherMEDICARE RAILROAD GROUP NUMBER
Q51832Medicare UPIN
MT1578518916Medicaid