Provider Demographics
NPI:1720033053
Name:CHISDAK, JAMI LORENE (MD)
Entity Type:Individual
Prefix:
First Name:JAMI
Middle Name:LORENE
Last Name:CHISDAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1648 ELLIS ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-8810
Mailing Address - Country:US
Mailing Address - Phone:406-556-4649
Mailing Address - Fax:406-556-7083
Practice Address - Street 1:905 HIGHLAND BLVD STE 4500
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6903
Practice Address - Country:US
Practice Address - Phone:406-556-5150
Practice Address - Fax:406-556-5175
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9885207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology