Provider Demographics
NPI:1750310843
Name:PALCHAK, ANDREW EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:EDWARD
Last Name:PALCHAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 SUNNYVIEW LANE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901
Mailing Address - Country:US
Mailing Address - Phone:406-752-6345
Mailing Address - Fax:406-752-6346
Practice Address - Street 1:210 SUNNYVIEW LANE
Practice Address - Street 2:SUITE 205
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901
Practice Address - Country:US
Practice Address - Phone:406-752-6345
Practice Address - Fax:406-752-6346
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMT4392207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT015002Medicaid
MT015002Medicaid