Provider Demographics
NPI:1578776118
Name:ALTHOUSE, DEE (MD)
Entity Type:Individual
Prefix:
First Name:DEE
Middle Name:
Last Name:ALTHOUSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEEANN
Other - Middle Name:ALTHOUSE
Other - Last Name:TILLEMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:521 4TH ST
Mailing Address - Street 2:
Mailing Address - City:HAVRE
Mailing Address - State:MT
Mailing Address - Zip Code:59501-3649
Mailing Address - Country:US
Mailing Address - Phone:406-395-4305
Mailing Address - Fax:406-395-4858
Practice Address - Street 1:521 4TH ST
Practice Address - Street 2:
Practice Address - City:HAVRE
Practice Address - State:MT
Practice Address - Zip Code:59501
Practice Address - Country:US
Practice Address - Phone:406-395-4305
Practice Address - Fax:406-395-4858
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT49457208000000X, 208D00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FA4581840OtherDEA
MTH58771Medicare UPIN