Provider Demographics
NPI:1659514149
Name:MAGILL, MARK ERICH (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ERICH
Last Name:MAGILL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:350 HERITAGE WAY
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3158
Mailing Address - Country:US
Mailing Address - Phone:406-752-6784
Mailing Address - Fax:406-756-4111
Practice Address - Street 1:350 HERITAGE WAY
Practice Address - Street 2:SUITE 1200
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3158
Practice Address - Country:US
Practice Address - Phone:406-752-6784
Practice Address - Fax:406-756-4111
Is Sole Proprietor?:No
Enumeration Date:2009-04-13
Last Update Date:2023-11-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MT40956207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNC2077Medicaid
NC0397730024Medicare NSC
NC1659514149Medicaid
NCNCH996AMedicare PIN