Provider Demographics
NPI:1629275425
Name:KEITH J. POPOVICH, M.D., PLLC
Entity Type:Organization
Organization Name:KEITH J. POPOVICH, M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:J
Authorized Official - Last Name:POPOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-782-8988
Mailing Address - Street 1:505 W PARK ST
Mailing Address - Street 2:
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:
Practice Address - Street 1:505 W PARK ST
Practice Address - Street 2:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000083138Medicare ID - Type UnspecifiedGROUP #